RESULTS OF 1,454 FREE RIGHT INTERNAL THORACIC-ARTERY TO CORONARY-ARTERY GRAFTS

Background. After beginning our use of bilateral internal thoracic art ery grafts in 1985, we found the pedicled right internal thoracic arte ry grafts limiting, and expanded the application of the right internal thoracic artery by elective use as a free graft. We evaluated the res ults of patients having a free right internal thoracic artery (FRITA)- to-coronary artery graft as part of their coronary revascularization. Methods. From 1986 to 1995, 1,454 patients had a FRITA graft. Preopera tive characteristics included mean age, 58.8 years (range 29 to 84 yea rs); non-insulin-dependent diabetes, 116 (8%); insulin-dependent diabe tes, 7 (0.5%); left ventricular ejection fraction from 0.30 to 0.40, 1 59 (11%); left ventricular ejection fraction less than 0.30, 14 (1%); and unstable angina, 144 (9.9%). In 11 patients the FRITA was the only graft, in 1,443 a left internal thoracic graft was also used and reva scularization completed with additional arterial and vein grafts. Ther e were 3.3 +/- 1.1 distal anastomoses per patient, the aortic clamp ti me was 49 +/- 12 minutes, and bypass time was 69 +/- 16 minutes. The F RITA was used to reach the circumflex marginal arteries in 718 patient s (49.5%), posterior descending artery in 286 (19.7%), diagonal or int ermediate in 172 (11.8%), left anterior descending artery in 119 (8.1% ), right coronary artery in 115 (7.9%), and left ventricular branch of right coronary artery in 44 (3%). The proximal anastomosis was direct ly on the aorta in 1,441, other arterial graft in 8, and vein graft in 5. Results. Operative mortality was 13 patients (0.9%); stroke occurr ed in 14 patients (1%) and myocardial infarction in 19 (1.3%). The pea k creatine kinase myocardial isoenzyme serum level was 20.6 +/- 13.6 I U/L. Complications included sternal infection in 18 patients (1.2%) an d reoperation for hemorrhage in 23 (1.6%). Survival at 5 and 7 years, respectively, was 96% +/- 2.1% and 94% +/- 2.5%. In 71 patients with a FRITA studied at a mean of 41.5 +/- 14 months postoperatively for rec urrent symptoms, 67 FRITA grafts were widely patent (94.5%), 3 display ed a string sign, and 1 was totally occluded. Conclusions. Use of the right internal thoracic artery as a free graft is safe and effective a nd allows greater flexibility in arterial coronary revascularization. (C) 1997 by The Society of Thoracic Surgeons.