Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries

The internal thoracic artery (ITA) has been established as the preferred conduit for myocardial revascularization. Several reported improved late results of coronary artery bypass grafting (CABG) with bilateral internal thoracic arteries (BITAs). In our institute, BITAs have been used for CABG from 1993. Since 1995, the indications for use of BITAs were extended to high risk patients. Between January 1995 and December 1997, 119 patients received BITAs for coronary artery revascularization. Right ITAs were anastomosed to the left anterior descending arteries (65%), the diagonal branches (7%), the left circumflex arteries (12%) and the right coronary arteries (10%). In 8 patients (7%), free right ITAs were used to bypass between proximal and distal portions of the right coronary artery. The hospital mortality rate was 4.2%. Regarding hospital morbidity, there were 2 patients with sternal infection and 2 patients with LOS postoperatively. There was no reoperation for bleeding. No significant difference was observed in the rate of wound infection or rate of operation without blood transfusion between the patients having BITAs grafting and those having unilateral ITA or saphenous vein grafting only, during the same period. Diabetes mellitus, older age, feminine gender, reduced ejection fraction and urgent operation are known risk factors for CABG. Among patients with these factors, no significant difference was observed in hospital mortality rate between patients with BITAs grafting and those with unilateral ITA grafting. The operative results of CABG using BITAs were considered to be satisfactory.