MYOCARDIAL REVASCULARIZATION WITH BILATERAL INTERNAL THORACIC ARTERY IN PATIENTS WITH LEFT MAIN DISEASE - AN INCREMENTAL RISK

Although the long-term patency of the internal thoracic artery (ITA) h as been well proved, there is still some concern about its preoperativ e performance. We considered 80 patients with left main disease (mean age 60.2 years) who underwent coronary artery bypass grafting in our i nstitute from March 1988 to September 1992. Patients with left main di sease were divided into 2 groups: group I - 38 patients receiving only ITA grafts on the left coronary system and group II - 42 patients hav ing a single ITA graft together with saphenous vein grafts on the left coronary system. No patients in group I received a saphenous graft on the left coronary system and three patients with right coronary arter y involvement received total arterial myocardial revascularization wit h the use of the inferior epigastric artery. Perioperative complicatio ns in group I and group II patients were, respectively: myocardial nec rosis in 2 (6.9%) and 3 (8.8%), use of intraaortic balloon pump in 2 ( 6.9%) and 2 (5.9%). No death occurred in either group. In our experien ce, the use of bilateral ITA grafts in patients with left main stenosi s was not related to an incremental risk. We conclude that left main d isease should not be considered as counterindication to the extensive use of arterial conduits.