Abstract 11741: The Free Right Internal Thoracic Artery: A Versatile and Durable Conduit
Objective: Despite its potential advantages, the right internal thoracic artery (RITA) is used as a conduit in only 4% of coronary revascularizations. To broaden its application, we frequently use the RITA as a free graft. Here we describe our experience with the RITA as an in-situ and free graft.
Methods: We reviewed the perioperative outcomes and angiographic patency rates of 479 consecutive patients who underwent RITA grafting between January 1987 and December 2011.
Results: The average age was 59 years with an average of 3.2 grafts per patient. The RITA was used free (FRITA) in 380 (79%) and in-situ in 99 (21%). The FRITA proximal anastomosis was taken directly from the aorta in 289 (76%), from the hood of a saphenous vein graft (SVG) if the aortic wall was thickened in 85 (22%), and from the LITA in 6 (2%) patients. The target for the in-situ RITA was the RCA (100%). Targets for the FRITA were PDA (41%), RCA (10%), circumflex-marginal (39%), and LAD (7%). There was no peri-operative mortality. Mean follow up was 9.4 years. There were 52 (10.9%) deaths, 9 (2.4%) sternal wound infections, 2 (0.4%) sternal non-unions, 1 (0.2%) redo-CABG, and 47 (9.8%) PCIs to non-ITA grafts. Catheterization was performed in 79 (16%) symptomatic patients at a mean interval of 6.9 years. The patency for all RITA was 96.2% (n=79), LITA 91.3% (n=69), and SVG 77% (n=100). The in situ RITA patency was 90.9% (n=22; 2 occluded grafts), while FRITA patency was 98.2% (n=57; 1 occluded graft). Kaplan-Meier 10-year survival for both in-situ and FRITA was 93%.
Conclusion The FRITA graft reaches all distal coronary vessels and has an excellent patency rate. Its application in coronary revascularization vastly expands the benefits of ITA grafting.
- © 2012 by American Heart Association, Inc.