Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage?

Abstract

Using in situ BITA with retrosternal in situ RITA for LAD grafting is a technically less demanding, safe, and effective strategy that can increase usage of BITA by avoiding a composite graft configuration or technically challenging retrocaval routing of in situ RITA through the transverse sinus.

Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease

“…[19][20][21] We skeletonized almost exclusively the right internal thoracic artery, routed anterior to the ascending aorta across the midline, and anastomosed to the distal left anterior descending artery, in an in situ, individual graft fashion. We chose this approach because right internal thoracic artery grafting to the right coronary artery has been shown to fail more frequently than grafting to the left coronary areas, 16 and decreased midterm survival and reduced patency of composite grafts have been reported.…”

Anaortic total arterial OPCAB – Panacea to all ills?

“…Cons of bilateral IMAs include increased length of operation, increased ventilation time, increased sternal wound reconstruction (1.9% vs 0.6%) and increased wound complications in diabetic patients. 37 Increase in sternal infection in bilateral IMAs was shown even by Raza et al, 38 but it did not have any effect on survival. To the contrary bilateral IMAs reduced the mortality by 21%.…”

Advancing the State of the Art in Surgical Coronary Revascularization

“…(4) As arterial grafting can be technically challenging, confirming patency with routine use of intraoperative graft flow measurements is important. (5) Finally, the present guidelines do not mention the value or role of all-arterial grafting. We consider that it should be a default operation for most patients undergoing CABG, in the absence of contraindications to this approach.…”

“…However, a few subtle but important points deserve attention. First, the authors recommend bypassing the left anterior descending coronary artery (LAD) with an internal thoracic artery (ITA), as opposed to a left ITA (LITA) in recognition that right and left ITAs have similar patency when grafted to the LAD [5]. Second, they recommend the use of "a second arterial conduit," acknowledging that the evidence base differentiating patency and clinical outcomes after radial artery (RA) versus RITA grafting is inconclusive.…”