Impact of sequential grafting of the internal thoracic or right gastroepiploic arteries on multiple coronary revascularization

Objective, The aim of the study is to clarify the efficacy of the sequentia l anastomotic technique of the arterial conduits for multiple coronary reva scularization. Background. The internal thoracic artery (ITA) is now widely accepted as a durable conduit for myocardial revascularization, The right gastroepiploic artery (GEA) has been developed as a third in situ arterial graft with an o utcome similar to that of the ITA, Material and method. One hundred and forty five consecutive patients (116 m ale, 29 female, mean age 60.4 yr) who received sequential grafting of eithe r the ITA or GEA or both were retrospectively analysed, Results. Sequential anastomoses were performed in 121 in situ left ITAs, 36 in situ GEAs and 12 composite right ITAs. No in situ right ITA was anastom osed sequentially. Two to six vessels (mean 3.8) were revascularized For ea ch patient. Of the total 543 bypassed vessels, 432 (79.6%) were reconstruct ed with the arterial grafts, In 85 patients with quadruple bypass or more. the arterial grafts were able to reconstruct 266 out of 360 (74.0%) target vessels. Seventy one patients (49.0%) were revascularized without venous gr afts. The arterial grafts could revascularize 293 out of 310 vessels (94.5% ) in the LAD similar to Diagonal region, 83 out of 113 (73.4%) in the dista l RCA or Cx region. There were no cardiac events responsible for the arteri al grafts in the follow up period, Conclusion. In light of our experience. multiple revascularization with in situ arterial sequential grafts is feasible. Aggressive application of this technique provides patients requiring multiple coronary revascularization with favorable long-term results. (C) 2000 The International Society for Ca rdiovascular Research. Published by Elsevier Science Ltd. All rights reserv ed.