ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
INFLUENCE OF THE PROXIMAL ANASTOMOSIS SITE ON THE LONG-TERM PATENCY OF FREE INTERNAL THORACIC ARTERY GRAFTS
Murat Mert, İhsan Bakır, Ahmet Özkara, *Alev Arat Özkan, *Erhan Babalık, Cenk Eray Yıldız, Cihat Bakay
İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kalp Damar Cerrahisi Ana Bilim Dalı, İstanbul
*İstanbul Üniversitesi Kardiyoloji Enstitüsü, Kardiyoloji Ana Bilim Dalı, İstanbul
Background: The usual proximal anastomosis site for free internal thoracic artery grafts (ITA) is the aorta or a pericardial patch layed on the aorta. A saphenous vein graft or the other in situ ITA should be considered in cases where the proximal anastomosis could not be done on the aorta. In the present paper, the influence of the proximal anastomosis site of free ITA grafts on the long-term outcome is studied.

Methods: Eighty-four patients with free ITAgrafts in whom the proximal anastomosis was on the other in situ ITA graft (Group 1) or on a saphenous vein (Group 2) were followed for a mean period of 38.1 ± 24 months. Fourty-eight patients (57.15 %) underwent control coronary angiography.

Results: In Group 1, 17 of 18 (94.44%) angiographically controlled patients had patent free ITA grafts where this number was 21/30 (70%) in Group 2. The difference between the groups did not reach a statistical significance (p = 0.067) but we clinically observed that free ITA grafts in Group 2 patients were more prone to stenosis due to problems with their saphenous vein and with the anastomosis line between the vein and the free graft.

Conclusion: Free ITA grafts should be considered before the saphenous vein grafts in cases where bilateral in situ ITA usage is not possible. The reported results of the proximal anastomosis on the aorta are acceptable for free grafts. In cases where this is not feasible, we have observed that the free grafts on the other in situ ITA has a better patency rate, even our results have bin not reach a statistical significance.

Keywords : Free internal thoracic artery graft, proximal anastomosis, saphenous vein graft
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