SAN DIEGO – Although the right internal thoracic artery is biologically identical to the left internal thoracic artery, it is rarely used in coronary artery bypass grafting. In a study comparing the use of different graft sources for coronary artery bypass grafting (CABG), Dr. James Tatoulis and his colleagues found that the right internal thoracic artery (RITA) showed equivalent results to using the left internal thoracic artery (LITA).
Dr. James Tatoulis
Dr. Tatoulis of the Royal Melbourne Hospital and his colleagues evaluated consecutive RITA graft angiograms performed between 1986 and 2008. Patency was examined over time, by coronary territory, and by whether in situ or free RITA, and was compared with other coronary conduits, according to the study, which was presented January 31 at the annual meeting of the Society of Thoracic Surgeons.
A total of 5,766 patients had a RITA graft, usually as part of bilateral internal thoracic artery CABG. The operative mortality was 1.1%, and the rate of deep sternal infection was 1.5%. Of the nearly 7,800 coronary conduits studied, 991 RITA conduits were examined at a mean of 100 months postoperatively.
The overall 10-year RITA patency was 90%. RITA graft patency to the left anterior descending artery (n = 149) was 95% at 10 years and 90% at 15 years. Ten-year RITA patency to the circumflex marginal artery was 91% (n = 436); to the right coronary artery (RCA), 85% (n = 199); and to the posterior descending artery (PDA), 86% (n = 207). Ten-year RITA and LITA patencies to the left anterior descending artery were identical.
In situ RITA (n=451) and free RITA (n=540) had similar 10-year patencies, 89% vs. 91% respectively.
RITA patency was found to be significantly better than radial artery and saphenous vein grafts for both, circumflex marginal, and RCA/PDA. The 10 year survival of patients with RITA and LITA for triple vessel coronary disease were identical at 89%.
Dr. Tatoulis and his colleagues stated that late patencies of RITA are excellent, equivalent to the LITA for identical territories, and always better than radial artery and saphenous vein grafts.
"Unfortunately, less than 10% of all coronary artery surgery worldwide is performed with two internal thoracic arteries," Dr. Tatoulis said in an interview.
He added that the use of this technique could improve patient outcomes and could offer an even better revascularization alternative to stents, particularly for triple-vessel coronary disease.
Dr. Tatoulis and his colleagues reported that they had no relevant disclosures.