Angiographic outcomes of right internal thoracic artery grafts in situ or as free grafts in coronary artery bypass grafting

Objective: We sought to compare early and 1-year angiographic results of various coronary artery bypass grafting configurations with the right internal thoracic artery in combination with the left internal thoracic artery. Methods: We reviewed the records of 705 patients who underwent bilateral internal thoracic artery grafting between September 2004 and November 2008. The right internal thoracic artery was used as an in situ graft in 547 patients and as a free graft in 158 patients. We compared operative and postoperative variables and early and 1-year angiographic patency rates of the right internal thoracic artery between the groups. Results: The operative mortality and incidence of postoperative complications were not significantly different between groups. The overall patency rates of the right internal thoracic artery were 98.8% at early angiography and 94.3% at 1-year postoperative follow-up. There were no significant differences in patency rate between in situ and free right internal thoracic artery grafts (98.6% vs 99.3% early and 95.3% vs 89.8% at 1 year). The best patency rate of the right internal thoracic artery was achieved with in situ grafting to the left anterior descending system (99.4% early and 98.5% at 1 year). Conclusions: Patency rates of in situ and free right internal thoracic artery grafts were similar in early and 1-year angiographic studies. Among various configurations, the best patency of the right internal thoracic artery was obtained with in situ grafting to the left anterior descending coronary artery. (J Thorac Cardiovasc Surg 2010; 139: 868-73)