All-artery multigraft coronary artery bypass grafting with only internal thoracic arteries possible and safe: a randomized trial

Background. The internal thoracic artery (ITA) bypass to the left anterior descending coronary artery is of proven benefit in multigraft coronary arte ry bypass. Total ITA grafts, if reoperation is averted by avoiding saphenou s vein grafts (SVGs), are attractive. The safety of the total ITA graft ope ration (all-ITA) is a concern. Methods. A randomized trial of multiple-ITA bypass graftings with the use o f bilateral sequential ITA without SVGs was performed. Control patients rec eived 1 ITA plus SVG. Inclusion criteria were those used in the Coronary Ar tery Surgery Study, extended to age 76 years, and any angina class, except emergent. One hundred sixty-two patients were randomized (81 patients per g roup) from January 1, 1990, to December 31, 1994. Results. Baseline traits were similar as were cross-clamp times, pump times , and number of arteries bypassed (average, 4.3 arteries). Patients who rec eived multiple ITA grafts had no myocardial infarctions, per reference labo ratory. One patient died, and 2 patients returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced successful comple tion in 93% of cases. Complications did not differ from control patients. Conclusions. Early and 5-year outcomes were not different between the all-I TA group and the ITA with SVGs group. We believe experienced surgeons can s afely extend the ITA to multibypass coronary artery bypass without use of S VG to achieve an all-ITA operation.