Myocardial revascularization with bilateral internal thoracic arteryin patients with left main disease: An incremental risk?

Although the long-term patency of the internal thoracic artery (ITA) hasbeen well proved, there is still some concern about its preoperativeperformance. We considered 80 patients with leftmain disease (mean age60.2 years) who underwent coronary artery bypass grafting in our institutefrom March 1988 to September 1992. Patients with left main disease weredivided into 2 groups: Group I-38 patients receiving only ITA grafts on theleft coronary system and group II-42 patients havin a single ITA grafttogether with saphenous vein grafts on the left coronary system. Nopatients in group I received a saphenous graft on the left coronary systemand three patients with right coronary artery involvement received totalarterial myocardial revascularization with the use of the inferiorepigastric artery. Perioperative complications in group I and group IIpatients were, respectively: Myocardial necrosis in 2 (6.9%) and 3 (8.8%), use of intraaortic balloon pump in 2 (6.9%) and 2 (5.9%). No death occurredin either group. In our experience, the use of bilateral ITA grafts inpatients with left main stenosis was not related to an incremental risk.Weconclude that left main disease should not be considered ascounterindication to the extensive use of arterial conduits. © Springer-Verlag 1994.