What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study

What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study

Objective. Bilateral internal thoracic artery (BITA) grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA) revascularization. The ideal functional BITA configuration remains controversial. Methods. P...

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Main Authors: Neragi-Miandoab, S., Michler, R. E., Lalezarzadeh, F., Bello, R., DeRose, J. J.
Format: Online
Language:English
Published: Hindawi Publishing Corporation 2014
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932723/
id pubmed-3932723
recordtype oai_dc
spelling pubmed-39327232014-03-20 What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study Neragi-Miandoab, S. Michler, R. E. Lalezarzadeh, F. Bello, R. DeRose, J. J. Clinical Study Objective. Bilateral internal thoracic artery (BITA) grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA) revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD) and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA) connections directly off the aorta (Ao) (n = 12) or as a “t” graft off the LITA (t) (n = 12). The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times (91.5 + 15.3 versus 68.0 + 12.5 minutes, P < 0.01) and total cardiopulmonary bypass times (109.0 + 16.2 versus 85.0 + 15.1 minutes, P < 0.01) were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow (38.3 ± 13.5 versus 22.1 ± 9.5, P < 0.01), mean RITA conductance (flow/mean arterial pressure) (0.45 ± 0.16 versus 0.28 ± 0.11, P < 0.01), RITA fractional flow (0.52 ± 0.15 versus 0.36 ± 0.11, P < 0.01), and RITA fractional conductance (0.51 ± 0.15 versus 0.36 ± 0.11, P < 0.01) than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of 42.8 + 6.6 months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33%) in the Ao group and 2 patients in the t group (16%). One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta provides more acute fractional RITA flow than composite “t” grafting to the LITA. Longer-term angiographic and clinical followup are necessary to determine the consequences of these acute hemodynamic findings. Hindawi Publishing Corporation 2014 2014-02-06 /pmc/articles/PMC3932723/ /pubmed/24653860 http://dx.doi.org/10.1155/2014/972832 Text en Copyright © 2014 S. Neragi-Miandoab et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Neragi-Miandoab, S.
Michler, R. E.
Lalezarzadeh, F.
Bello, R.
DeRose, J. J.
spellingShingle Neragi-Miandoab, S.
Michler, R. E.
Lalezarzadeh, F.
Bello, R.
DeRose, J. J.
What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
author_facet Neragi-Miandoab, S.
Michler, R. E.
Lalezarzadeh, F.
Bello, R.
DeRose, J. J.
author_sort Neragi-Miandoab, S.
title What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
title_short What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
title_full What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
title_fullStr What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
title_full_unstemmed What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study
title_sort what is the best proximal anastomosis for the free right internal thoracic artery during bilateral internal thoracic artery revascularization? a prospective, randomized study
description Objective. Bilateral internal thoracic artery (BITA) grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA) revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD) and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA) connections directly off the aorta (Ao) (n = 12) or as a “t” graft off the LITA (t) (n = 12). The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times (91.5 + 15.3 versus 68.0 + 12.5 minutes, P < 0.01) and total cardiopulmonary bypass times (109.0 + 16.2 versus 85.0 + 15.1 minutes, P < 0.01) were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow (38.3 ± 13.5 versus 22.1 ± 9.5, P < 0.01), mean RITA conductance (flow/mean arterial pressure) (0.45 ± 0.16 versus 0.28 ± 0.11, P < 0.01), RITA fractional flow (0.52 ± 0.15 versus 0.36 ± 0.11, P < 0.01), and RITA fractional conductance (0.51 ± 0.15 versus 0.36 ± 0.11, P < 0.01) than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of 42.8 + 6.6 months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33%) in the Ao group and 2 patients in the t group (16%). One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta provides more acute fractional RITA flow than composite “t” grafting to the LITA. Longer-term angiographic and clinical followup are necessary to determine the consequences of these acute hemodynamic findings.
publisher Hindawi Publishing Corporation
publishDate 2014
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932723/
_version_ 1612061168067674112

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