Technical aspects and outcome of in situ right internal thoracic artery grafting to the major branches of the circumflex artery via the transverse sinus

Background. Little is known about the anatomic limitations of in situ right internal thoracic artery (RITA) grafting to the circumflex artery. Methods. To evaluate the technical aspects and outcome of revascularization of the proximal and distal major branches of the circumflex artery (obtuse marginal [OM] branch and posterolateral [FL] branch), a total of 145 patie nts who possessed a graftable branch of the circumflex artery were enrolled into the prospective project. There were 73 patients who had the FL branch as a primary target and 72 patients with OM branches, which were allocated by a blinded observer who reviewed the preoperative angiography. Results. Changes of primary target vessels were required in 9 patients (6.2 %), yielding an overall success rate of RITA grafting of 93.8%. The success rates of RITA grafting to the OM branch and the PL branch were 95.8% (69/7 2; CI 88.3% to 99.1%) and 91.7% (67/73; CI 83.0% to 96.9%), respectively. T he univariate analysis identified grafting under hypothermic ventricular fi brillation as predictors of inability to use in situ RITA grafting for reva scularization of the circumflex artery. RITA grafting to the PL branch is n ot identified as a predictor. Postoperative angiography in 136 patients rev ealed only one occlusion (0.75%) of the RITA graft anastomosed to the margi nal artery. There were no significant differences in patency rates between left and right ITA grafts. Conclusions. This prospective study showed that in situ RITA was, in most c ases, able to reach most branches of the major circumflex artery and demons trated an excellent patency rate. (Ann Thorac Surg 2001;71:1485-90) (C) 200 1 by The Society of Thoracic Surgeons.