Right coronary artery revascularization in patients undergoing bilateral internal thoracic artery grafting: comparison of the free internal thoracic artery with saphenous vein grafts

From April 1996 to July 1999, 241 consecutive patients underwent complete arterial revascularization with composite T-graft, including right coronary artery grafting with free right internal thoracic artery (ITA) (ITA group). They were compared with 127 bilateral ITA patients in whom saphenous vein grafts (SVG) was used for grafting the right coronary system (SVG group). The SVG group included more diabetics (40 vs. 29%), more emergency cases (21 vs. 12.4%), and the number of anastomoses per patient was higher (3.8 vs. 3.35, P=0.025). Thirty-day mortality was 3.9 and 4.1% in the SVG and the ITA groups, respectively (P=NS). Occurrence of perioperative complications (sternal infection, myocardial infarction, cerebrovascular accident, and bleeding) was not statistically significant. However, in sum, the complications rate was higher in the ITA group (8.3 vs. 2.4%, P=0.032). Midterm followup (2-56 months) showed increased return of angina in the ITA group (9.1 vs. 1.6%, P=0.00). However, 4-year survival (Kaplan-Meier) was comparable (91.7% in the SVG and 87% in the ITA group). In conclusion, early results of complete arterial revascularization with composite T-graft are similar to those of bilateral ITA grafting of the left and right system revascularization with SVG. However, lower return of angina in the SVG group makes SVG grafting preferable for the right coronary system.