Bilateral internal thoracic artery surgery: 17-year experience

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Abstract
Angiographic comparisons of late morphology of internal thoracic artery (ITA) and saphenous vein grafts (SVG) in the same patients established morphologic superiority of the ITA grafts (1983). 15-year clinical follow-up of 748 consecutive patients having ITA and SVGs (532) or SVGs alone (216) established the clinical advantages given to patients by ITA grafts (1986): (1) higher cumulative survival rate (P < 0·01); (2) less early recurrence of angina (P<0·-01); (3) fewer late myocardial infarctions (P<0·02); (4) lower reoperation rate (P<0·001). Benefits to patients having bilateral ITA grafts (38) exceeded even those of single ITA grafts: (I) operative mortality = 0%; (2) cumulative survival (10 years) =890%; (3) annual recurrence of angina = 1·5%; (4) annual late myocardial infarction = 1·1%; (5) mortality rate = 0%; (6) annual reoperation rate = 0%. These data prompted routine use of bilateral ITA grafts for all patients requiring multiple bypasses, and use of each IT A for as many bypasses as seemed feasible. Since 1986, ITA anastomoses have accounted for two thirds of anastomoses in all patients requiring multiple bypasses (average 3·2 anastomoses/patient). Results have been gratifying. Potential technical pitfalls are emphasized, and means of avoiding them described.

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