Coronary-Coronary Bypass Using the Internal Thoracic Artery: A Sparing Procedure of the Arterial Conduit

Abstract

Background: The internal thoracic artery (ITA) is well known t o be the best conduit for coronary artery bypass grafting. However, the bilateral use of ITAs remains limited because in situ right ITAs (RITAs) do not possess an adequate length t o be directed t o t h e posterolateral myocardium. We thus considered using free ITAs for conduits between the t w o segments of the same coronary artery. Methods: From March 1997 t o May 1999,17 patients underwent coronary-coronary bypass grafting (C-CBG) using free ITAs. Early operative results were analyzed. C-CBG was indicated when the right ITA had an inadequate length or when a distal part of t h e ITA was left unused. Results: No patient died after C-CBG and none have experienced angina since C-CBG (mean follow-up period 27.3 ? 19.8 months). Postoperative angiography was performed in all subjects at discharge. Only one coronary-coronary bypass graft was occluded, the other grafts were patent, and there were no stenotic changes. Bilateral ITAs were used in 75% of the patients undergoing CABG during the period Address for correspondence: Takashi Hirotani, M.D., Department of Cardiovascular Surgery, Tokyo Saiseikai Central Hospital, 1-7-14 Mita, Minato-ku, Tokyo 108-0073, Japan. Fax: 03-3457-7949.