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(Circulation. 2001;104:2152.)
© 2001 American Heart Association, Inc.

Editorials

Superiority of Bilateral Internal Thoracic Artery Grafting

It’s Been a Long Time Comin’

Bruce W. Lytle, MD; Floyd D. Loop, MD

From the Department of Thoracic and Cardiovascular Surgery, the Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Bruce W. Lytle, MD, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-25, Cleveland, Ohio 44195. E-mail lytleb@ccf.org

Key Words: Editorials • grafting • bypass

A myriad of data have established the superiority of the left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery.^1,2 Late patency rates of LITA-LAD grafts far exceed those of saphenous vein grafts (SVG) to the LAD, and ITA grafts avoid the late complications of vein graft atherosclerosis.³ Once an ITA graft is patent, late failure is extremely rare. These advantages are reflected in improved clinical outcomes. When compared with patients receiving only SVGs, patients receiving LITA-to-LAD grafts and SVGs to other vessels experience an improved long-term survival rate, fewer reoperations, and fewer cardiac hospital admissions.^1,2

See p 2164

If one ITA graft is good, might two be better? Even before the demonstration of the benefit of LITA-LAD grafts in the 1980s, a minority of coronary artery surgeons used bilateral ITA (BITA) grafts for selected patients based on the premise that more extensive ITA use might further improve outcomes. However, the incremental benefit of BITA grafts over the LITA-LAD plus SVG strategy has been difficult to document, despite its apparent logic.

Why has the benefit of BITA grafting been difficult to show? Probably for multiple reasons. First, the LITA-LAD plus SVG strategy produces very good outcomes during the first postoperative decade. Therefore, to show improved outcomes, a large sample size is needed and those patients must be followed for relatively long postoperative intervals. BITA grafting has not been a common operation at most institutions, and the length of follow-up has often been short. Also, if it . . . [Full Text of this Article]

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