Sequential free right internal thoracic artery grafting for multivessel coronary artery bypass grafting

Objectives: This study compared early and follow-up angiographic results of individual and sequential grafting with the free right internal thoracic artery (RITA). Methods: We reviewed 334 patients who underwent multivessel coronary artery bypass grafting with the free RITA between September 2004 and December 2010. The free RITA was used for individual grafting in 179 patients and for sequential grafting in 155 patients. We compared operative and postoperative variables and early and follow-up angiographic patency rates of distal anastomoses of the free RITA between the groups. Results: The mean number of distal anastomoses in sequential grafting was 2.2 +/- 0.4. The inflow of the free RITA included the aorta (27.4%) and other grafts (72.6%) in the individual group. The inflow of free RITA was exclusively other grafts in the sequential group. Operative mortality and incidence of postoperative complications were not significantly different between groups. Overall patency rate of distal anastomosis of the free RITA was 99.1% at early angiography and 91.8% at follow-up angiography, and the rate did not differ significantly between individual and sequential grafting (early, 98.6% vs 99.3%; follow-up, 93.0% vs 91.2%). Conclusions: Multivessel coronary artery bypass grafting with the free RITA is safe and useful. Patency rates of distal anastomoses are similar between individual and sequential grafting with the free RITA at early and follow-up angiography. When the RITA cannot be used as an in situ graft for multiple anastomoses, sequential grafting with the free RITA should be considered. (J Thorac Cardiovasc Surg 2012; 144: 824-9)