• Circulation · Sep 2008

    Randomized Controlled Trial Comparative Study

    Comparison of bilateral internal thoracic artery revascularization using in situ or Y graft configurations: a prospective randomized clinical, functional, and angiographic midterm evaluation.

    • David Glineur, Claude Hanet, Alain Poncelet, William D'hoore, Jean-Christophe Funken, Jean Rubay, Joelle Kefer, Parla Astarci, Valerie Lacroix, Robert Verhelst, Pierre Yves Etienne, Philippe Noirhomme, and Gebrine El Khoury.
    • Service de Chirurgie cardiovasculaire et thoracique, Cliniques Universitaires Saint-Luc - U.C.L.90, Avenue Hippocrate 10/6107, 1200 Bruxelles, Belgium. david.glineur@clin.ucl.ac.be
    • Circulation. 2008 Sep 30; 118 (14 Suppl): S216-21.

    BackgroundBilateral internal thoracic arteries (BITA) demonstrated superiority over other grafts to the left coronary system in terms of patency and survival benefit. Several BITA configurations are proposed for left-sided myocardial revascularization, but the ideal BITA assemblage is still unidentified.Methods And ResultsFrom 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. 481 patients met the inclusion criteria for randomization, and 304 (64%) were randomized. Patients were allocated to BITA in situ grafting (n=147) or Y configuration (n=152) then evaluated for clinical, functional, and angiographic outcome after 6 months and 3 years. Patient telephone interviews were conducted every 3 months and a stress test performed twice yearly under the referring cardiologist's supervision. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end points were, respectively, major adverse cerebrocardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized to the Y than the in situ configuration (3.2 versus 2.4; P<0.001). No significant difference between the 2 groups in terms of hospital mortality or morbidity was found. At follow-up, there was no significant difference in any MACCE rate between the 2 groups. 450 out of 464 anastomosis (97%) in the BITA Y group and 287 of 295 (97%) in the BITA in situ group were controlled patent (P=0.99).ConclusionsExcellent patency rates were achieved using both BITA configurations with no significant differences in terms of MACCE up to 19 months postoperatively, but longer-term results remain to be established.

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