SUITABILITY AND DURABILITY OF MULTIPLE INTERNAL THORACIC ARTERY CORONARY-ARTERY BYPASSES

Objective The authors evaluate operative and extended outcomes of coro nary artery bypass surgery using the bilateral internal thoracic arter ies (ITAs) as bypass grafts. The authors conclude that the procedure i s viable and of long-term benefit to most patients. Summary Background Data Multiple ITA grafting was met with early enthusiasm by the surgi cal profession, but skepticism and controversy arose with reports of i ncreased operative morbidity, insufficient graft blood flow, a high in cidence of failure of the right ITA, and uncertainty about durability and long-term benefits. Methods To assess the actual incidence and imp act of these complications and long-term results, the authors prospect ively studied 500 consecutive patients with multiple ITA bypasses, con stituting the closely observed and carefully documented experience of one surgeon over an 11-year period. Results Operative mortality in the series of 500 patients was 1.8%, perioperative myocardial infarction (new Q wave) rate was 0.6%, and deep sternal wound infection occurred in 1%. Six patients (1.2%) had strokes, and nine patients (1.8%) were returned to the operating room to control bleeding. One hundred ninety -eight patients who had abnormal stress test results before surgery we re retested within 3 months of surgery. Ninety-four percent of these w ere normal, 3% were nondiagnostic, and 3% were abnormal. After a mean followup of 7.1 years (mode, 7.2 years), 87.5% of patients in the samp le were alive, and 93.2% of this group have experienced continuing goo d clinical results (New York Heart Association class I or II). Eighty- nine patients who underwent an angiogram had 90.8% patency rates of IT A bypasses and 84.5% patency of vein grafts. Only two patients require d repeat operations. Conclusions The operative results did not support the contention that the coronary artery bypass using ITA procedure pr oduces higher than acceptable mortality and morbidity rates. Multiple ITA bypasses can be performed without excessive morbidity, with low re operation rates and long-term outcomes that should encourage skeptics to reconsider the procedure's clinical value.