Abstract 1564: Does Location of the Second Internal Thoracic Artery Graft Influence Outcome?
Objectives: To determine whether location of the second internal thoracic artery (ITA) graft used for bilateral ITA grafting affects mortality and morbidity of patients with 3-system coronary artery disease, and to identify factors associated with location of the second ITA.
Methods: From 1/1972 to 6/2006, 3,611 patients with 3-system coronary artery disease underwent bilateral ITA grafting with one ITA to the left anterior descending (LAD) system and the second to either the circumflex (LCx; n=2,926) or right coronary artery (RCA; n=685) system. Follow-up was 9.2±7.2 years. Propensity score methodology was used to obtain risk-adjusted outcome comparisons between patients with the second ITA to the LCx vs RCA.
Results: In-hospital mortality (0.34% vs 0.58%; P=.4), stroke (0.96% vs 0.88%; P=.8), myocardial infarction (1.3% vs 0.73%; P=.2), renal failure (0.44% vs 0.29%; P=.6), respiratory insufficiency (3.5% vs 3.8%; P=.7), and reoperation for bleeding (3.4% vs 3.2%; P=.8) were similar in patients who received the second ITA to the LCx or RCA, and remained similar after propensity score adjustment. Late survival was also similar (Fig⇓.). Despite this, there has been a gradual decline in ITA to RCA grafting, particularly in the presence of severe LCx disease, but more use in women and in patients without RCA occlusion or distal stenoses.
Conclusions: Contrary to prevailing wisdom that the second ITA graft should be anastomosed to the next most important left-sided coronary artery in 3-system disease, the second ITA graft may be placed to either the LCx or RCA system with similar early and late outcomes.