Objective: Sequential internal thoracic artery (ITA) grafting allows a more
complete arterial revascularization of the myocardium. We wanted to verify
whether the excellent clinical and angiographic short term results reporte
d by us before where maintained over 10 years and more. Methods: the first:
consecutive 500 patients having received at least one sequential ITA graft
between October 1985 and August 1991 were reviewed. Age averaged 61 years.
Fifty-three patients had a left ventricular ejection fraction less than 40
%, 117 were not elective, 35 (7%) were reoperations, 56 (11%) had diabetes,
In total 2156 anastomoses were constructed (4.3/patient), among them 1367
arterial anastomoses (2.7/patient) and 1150 sequential ITA anastomoses (2.3
/patient). The clinical follow-up was 97.4% complete and averaged 9.6 (rang
e 8.6-13.6) years. One hundred and sixty-one patients consented to a late a
ngiographic restudy after a mean interval of 7.4 (range 1-12.2) years. Resu
lts: At 5 and 10 years, 89 and 72% of the patients were still alive. At 10
years 82% are still asymptomatic and 71% free of any type of ischaemia. Onl
y four patients (0.8%) needed a repeat surgical revascularization, and 11 (
2.3%) a percutaneous coronary angioplasty. At 5 and 10 years, 92.8 and 69%
of the patients remained free of any cardiac event. Overall, 95.5% of the a
rterial anastomoses were patent and 96.1% of the sequential ITA were patent
. There was a significant difference between the patency rate of pedicled I
TA and free ITA anastomoses: 96.3 vs. 86.5% (P = 0.02). There was no differ
ence in patency between left ITA and right ITA anastomoses for the LAD and
Cx areas. Sequential ITA anastomoses showed excellent patency rates to all
coronary vessels but the very distal circumflex and the distal branches of
right coronary artery (85%). There was no significant difference between th
e patency of the proximal and the distal sequential ITA anastomoses. The se
quential anastomoses constructed in the length tend to remain more patent t
han the diamond-shaped ones: 97.2 vs. 91.5% (P = 0.004). Conclusions: Seque
ntial ITA grafting optimizes arterial revascularization. The long-term pate
ncy is excellent, is identical to that of single ITA grafting, and appears
not much different from postoperative patency. The need for repeat surgical
and interventional revascularization has been extremely low: 3.1% over the
whole follow-up. (C) 2000 Elsevier Science B.V. All rights reserved.