Long-term results of bilateral internal thoracic artery grafting

Background. Little is known about the long-term results of the uniform grou p of patients who had bilateral internal thoracic artery (ITA) grafting wit h the method of left ITA-to-left anterior descending coronary artery and ri ght ITA-to-circumflex artery. Methods. Late follow-up study was performed in the first consecutive 203 pa tients (mean age, 62.6 +/- 9.1 years) who underwent isolated coronary arter y bypass grafting with the left ITA anastomosed to the left anterior descen ding coronary artery and the right ITA to major branches of the circumflex artery. The patients were grouped according to the patency of ITA grafts de monstrated by early postoperative angiography (Both patent (BP) group, 168 patients: both ITAs showed complete patency; Not patent (NP) group, 23 pati ents: at least one ITA was dysfunctional). Results. Actuarial 7-year survival in all patients was 89.3% +/- 3.1%. The cumulative probability of event-free survival for cardiac death, myocardial infarction, intervention, and angina at 7 years was 96.6% +/- 1.8%, 98.0% +/- 1.5%, 86.7% +/- 3.2%, and 90.7% +/- 2.9%, respectively. NP group had mo re myocardial infarction and angina than the BP group, but was not statisti cally significant. Because of failed grafts at the early angiography, inter vention was performed more frequently in NP group (p < 0.01). Conclusions. Our results of actuarial 7-year survival and the cumulative pr obability of event-free survival were at least comparable to the results of other similar studies using bilateral ITA. The freedom from angina appeare d to be better than in the previous study. Overall our study supports the c ontinued use of this method of ITA grafting. (Ann Thorac Surg 2000;70:1991- 6) (C) 2000 by The Society of Thoracic Surgeons.