This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nishida, H. Articles by Kasanuki, H. Search for Related Content PubMed PubMed Citation Articles by Nishida, H. Articles by Kasanuki, H. Related Collections CV surgery: coronary artery disease

(Circulation. 2001;104:I-76.)
© 2001 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Coronary Artery Bypass With Only In Situ Bilateral Internal Thoracic Arteries and Right Gastroepiploic Artery

Hiroshi Nishida, MD; Yasuko Tomizawa, MD; Masahiro Endo, MD; Hitoshi Koyanagi, MD; Hiroshi Kasanuki, MD

From the Departments of Cardiovascular Surgery and Cardiology (H.K.), The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, Japan.

Correspondence to Hiroshi Nishida, MD, Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan. E-mail snishida{at}hij.twmu.ac.jp

Background— With the rapid advance of catheter intervention, the direction taken by surgeons is not only to make conventional CABG less invasive but also to pursue better long-term results by using more arterial conduits.

Methods and Results— Between July 1989 and April 2000, 239 patients (218 men, 21 women) with a mean age of 59.7 (range 39 to 79) years underwent CABG with exclusive use of both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). ITA grafts were harvested by using the skeletonization technique. Most patients (96%) had either triple-vessel or left main disease. Fifty percent of the patients were diabetic, and 16 were being treated with insulin. The left ventricular ejection fraction was 40% in 46 patients (19%). Eleven patients (5%) had chronic renal failure and were on hemodialysis. Follow-up was completed in 235 patients (98%). Postoperative follow-up averaged 43 (range 1 to 129) months. Sequential grafting was performed in 64 patients, and the mean number of anastomoses was 3.3. One patient (0.4%) died of mediastinitis on the 53rd postoperative day. Graft patency was confirmed angiographically in 230 patients (96%) 2 to 3 weeks after surgery. The patency rate was 97.1% for the left ITA, 99.6% for the right ITA, and 95.5% for the RGEA. Five-year actuarial survival rate was 92.9%, and the cardiac death-free rate was 97.8%.

Conclusions— Complete arterial grafting with both ITAs and RGEA was associated with minimal operative risk, a high early graft patency rate, and excellent long-term results.

Key Words: bypass • surgery • revascularization • arteries