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Schneider Y.A., Tsoi V.G., Cherkes A.N., Shilenko P.A., Khudenkih E.E.
Federal Center of High Medical Technologies Ministry of Health of the Russian Federation (Kaliningrad)
The use of two internal thoracic artery as the gold standard of the coronary bypass surgery.
Actuality: Coronary artery bypass grafting (CABG) is the preferred method of myocardial revascularization
in patients with multifocal coronary artery disease. Using the left internal thoracic artery (LIMA) and the
great saphenous vein is still considered the gold standard for CABG. Most surgeons still don't want to use
two internal thoracic artery because they believe this process is technically more difficult, time-consuming
and associated with a higher risk of infectious complications.
Materials and Methods: In the period from 09.2012 to 12.2015 in our clinic performed 912 operations
isolated coronary artery bypass grafting using two internal thoracic arteries. Our tactic in the performance
of myocardial revascularization: the small size of the heart and good distal bloodstream-off pump CABG;
the large size of the heart, the critical coronary disease (critical stenosis LCA + RCA occlusion),
hemodynamic or heart rhythm instability- operation in a parallel extracorporeal circulation; bad distal
bloodstream- operation with extracorporeal circulation and ante- retrograde blood cardioplegia. We made
an analysis of the results of these operations on several criteria: patient's age, type of perfusion during
surgery, the number of conduits, the volume of blood loss (ml), hospital mortality, perioperative
myocardial infarction, the incidence of non-infarction heart failure, resternotomy about bleeding, the
frequency of infectious complications from the sternum (minor infection, mediastinitis), the incidence of
neurological complications (stroke).
Results: The isolated CABG using 2 ITA made 626 (68.6%) men and 286 women. The average age of
patients was 65.5 years. 396 (43.5%) patients underwent isolated CABG using 2 ITA OPCAB, 264
(28.9%) patients underwent beating-heart on-pump grafting and 252 (27.6%) patients - on-pump grafting
and cardioplegia. The average operation time: isolated off-pump CABG - 150 minutes, 220 minutes beating-heart on-pump and on-pump grafting and cardioplegia - 214 minutes. The average number of
grafts -3.1. In all groups of patients was observed low incidence of myocardial infarction in the early
postoperative period (5 patients (0,5%)). 49 (5,4%) patients had development of acute heart failure. The
average volume of intraoperative blood loss was 470 ml. Infectious complications of the sternum was
observed in 9 (0.97%) patients. It was performed 25 (3.2%) resternotomy about bleeding. Stroke in the
early postoperative period was observed in 1 (0.1%) patients. There was 1 (0.12%) lethal outcome.
Within three years under the supervision there were 318 patients. Total mortality was 4.7% ( 15 patients).
Freedom from angina and cardiac events - 82.1%. Needed a redo-CABG was 0. Need for cardiac
interventions ( PTCA or stent ) was 9 (2.8%).
Conclusion: Isolated CABG using 2 ITA immediately after surgery accompanied by low incidence of heart
failure, perioperative myocardial infarction, resternotomy about bleeding, infectious complications of the
sternum (minor infection, mediastinitis), intraoperative blood loss, need for transfusion of blood
components, neurological complications and good follow-up ( 2 years) results.