Patency of internal thoracic artery compared to vein grafts - Postoperative angiographic findings in 1189 symptomatic patients in 12 years

Background: The evidence respecting the superior patency of ITA-grafts compared to SVG is conclusive. This study evaluates the angiographic findings in 1189 symptomatic patients who received either one or both ITA-grafts with or without additional SVG. Methods: 1189 patients (975 males, aged 62.4+/-9.1 years), operated between 2/93 and 7/05, underwent angiography due to reappearance of angina. Data were compared for patency of single ITA (n=618), bilateral ITA (n=416) or SVG (n = 2218). Re-catherization was performed after 3.8+/-2.7 years. Severe bypass stenosis or graft occlusion was related to the target vessels. Results: 3668 bypasses were performed in 1189 patients. The occlusion rate was 16.5% for SVG and 7.0% for all ITAs (p < 0.001). Severe stenosis was detected in 4.8% of SVG and in 3.7% of ITAs (p < 0.05). Patency was 89.6% for LITA, 88.7% for RITA, and 78.7% for SVG. The occlusion rate for LITA was: to LAD 6.6%, DIA 8.5%, obtuse marginal branch/CX 11.5%. The occlusion rate for RITA was: to LAD 4.6%, RCA 9.1%., diag. branch 7.1%. The occlusion rate for vein grafts was: to LAD 17.3%, DIA 14.4%, obtuse marginal branch/CX 15.9%, to RCA 17.0%. Patency for all ITAs was 89.3% vs.78.7% for all SVG (p < 0.05). Despite symptoms, bypass patency was found in 711 patients (59.8%). Conclusion: The superior patency of ITA-grafts could be documented angiographically in a negatively selected, symptomatic population. Graft occlusion was at least twofold higher for SVG.