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Mitsumasa Hata
Motomi Shiono
Akira Sezai
Nanao Negishi
Yukiyasu Sezai
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Right arrow Coronary disease

Ann Thorac Surg 2004;78:477-480
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Midterm results of coronary artery bypass graft surgery with internal thoracic artery under low free-flow conditions

Mitsumasa Hata, MDa*, Motomi Shiono, MDa, Tatsuya Inoue, MDa, Akira Sezai, MDa, Nanao Negishi, MDa, Yukiyasu Sezai, MDa

a The Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Hata, The Second Department of Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi Kamimachi Itabashi-ku, Tokyo 173-8610, Japan
e-mail: mihata{at}med.nihon-u.ac.jp

BACKGROUND: We use the left internal thoracic artery (LITA) even when flow is very low. In this study, we investigated midterm outcome of coronary artery bypass graft surgery with low free-flow LITA.

METHODS: One hundred patients undergoing coronary artery bypass graft surgery using LITA with a free flow of less than 20 mL/min were reviewed. The mean follow-up duration was 47.4 months, ranging from 1 to 65 months. Graft angiography was performed postoperatively. The diameter of the LITA was assessed angiographically. Cumulative graft patency, cardiac-related event-free rate, and actuarial survival rate were calculated by the Kaplan-Meier method.

RESULTS: An early postoperative Doppler study showed that the diastolic-to-systolic ratio in the LITA was 1.76 ± 0.33. A 1-month postoperative angiography revealed LITA string sign in 2 patients. One had a percutaneous coronary intervention, whereas string sign was not detected in the second patient, and LITA patency showed a marked improvement in 1-year postoperative angiogram. One month postoperatively the LITA diameter was 1.6 ± 0.4 mm, and significantly enlarged in the second angiogram (1.9 ± 0.4 mm, p = 0.0003). There was a significant correlation between the diameter of the LITA and the left anterior descending coronary artery (r = 0.889, p = 0.0001). The cumulative graft patency rate at 1 and 4 years was 99.0% and 94.3%, respectively. The cardiac-related event-free rate at 1 and 5 years was 97.0% and 93.3%, respectively. The actuarial survival rate at 5 years was 97.1%.

CONCLUSIONS: Even with a very low LITA free flow, graft function improves with LITA growth, if there was no mechanical damage that impedes recovery.






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