Sequential Internal Thoracic Artery Graffing in Coronary Bypass Surgery

Tevfik TEZCANER, Cem YORGANCIOĞLU, Zeki ÇATAV, Hilmi TOKMAKOĞLU, Oğuz MOLDİBİ, Barlas AYTAÇOĞLU, Kaya SÜZER, Yaman ZORLUTUNA

Bayındır Tıp Merkezi, Toraks ve Kalp Damar Cerrahisi Kliniği

From 1992 to April, 1998, coronary bypass was performed on 3053 cases. Sequential İnternal thoracic artery grafting was used in 34 patients. Therc were 27 male, and 7 female patients; whose ages ranged from 40 to 78 (m: 59.3±9.4). Five patients underwent coronary bypass without cardiopulmonary bypass. Number of distal bypasses wcre between 2-6 (m: 4.1±1.1). Configuration of sequential İnternal thoracic artery was to left anterior descending artery - diagonal artery - right posterior descending artery - left anterior descending artery in 8 cases, and to proximal left anterior descending artery - distal left anterior descending artery in 25 cases. Aneurysmec- tomy in 2 cases, mitral valve replacement in l case, and ascending - descending aortic bypass due to coarctation in l case was performed as associated procedures.

In the early postoperative period, reoperation due to excessive bleeding vvas performed on 2 patients, and there was a case of cerebrovascular accidtmt in 1 patient. Perioperative myocardial infarction and mortality did not occur. Ali of the cases have been followed, and follow-up time ranged from 1 to 36 months (m: 11.7±10.6), 399 patient-months. Prema ture angina did not develop in any of the patients. Magnetic resonance imaging revealed a patent İnternal thoracic artery 2 months postoperatively in a patient who had been operated on for coronary artery disease associated with coarctation of the aorta, in another case, control coronary arteriogra- phy revealed a patent sequential İnternal thoracic artery 16 months postoperatively.

Use of sequential İnternal thoracic artery does not increase morbidity in the early postoperative period, and has long-term advantages.

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