Ann Cardiovasc Surg | Volume 4, Issue 1 | Research Article | Open Access

Is Sequential Grafting an Added Value in Coronary Bypass Surgery Using Bilateral Internal Thoracic Artery?

Olivier JL Jegaden1,2,3*, Amar O Hassan2, Margaux PO Jegaden4, Fadi Farhat3,5, Armand Eker6 and Joel Lapeze7

1Department of Cardiac Surgery, Mediclinic Middle East, UAE 2MBRU University, Dubai, UAE 3UCLB University Lyon, France 4INSERM U1151, Institute Necker, France 5Department of Cardiac Surgery, HCL, France 6Centre Cardio-Thoracic, Monaco, Monaco 7Department of Cardiac Surgery, Infirmerie Protestante, France

*Correspondance to: Olivier Jegaden 

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Objectives: It is unclear whether the additional bypass technique to supplement Bilateral Internal Artery grafting (BITA) influences the patient outcome in coronary surgery. We analyzed the impact on late survival after BITA of sequential ITA grafts use on the left side and of the third associated conduit on the right side.
Methods: From 1989 to 2014, 2,477 patients underwent BITA surgery. The revascularization of the left side was optimized with a sequential ITA graft in 1,144 patients. The revascularization of the right side was performed with an associated vein graft in 599 patients and with an associated Gastroepiploic graft (GEA) in 833 patients; it was not indicated or not accessible in 1,045 patients. The primary end point was overall mortality from any cause. The mean postoperative follow-up was 13.3 ± 7.1 years and 94% complete.
Results: The population was not homogenous: greater the arterial revascularization, lower the risk profile. The 30-day mortality was 1.4% without influence of the surgical technique performed. Late mortality was significantly influenced by age, heart failure, LV ejection fraction and diabetes. In multivariate analysis with Cox model (Chi-square 624.949, df11, p=0.001), the use sequential ITA graft was the only technical significant independent prognosis factor of survival, predominant over complete revascularization. The revascularization of the right side (GEA, vein, or no graft) had no influence on long-term survival.
Conclusion: These results confirm that higher the number of ITA anastomoses, better the longterm survival. It is a strong support of the extensive use of arterial grafting with multiple ITA bypass.


Coronary disease; Arterial revascularization; Internal thoracic artery; Gastroepiploic artery; Sequential graft


Jegaden OJL, Hassan AO, Jegaden MPO, Farhat F, Eker A, Lapeze J. Is Sequential Grafting an Added Value in Coronary Bypass Surgery Using Bilateral Internal Thoracic Artery? Ann Cardiovasc Surg. 2021;4(1):1029..

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