Objectives: For the left coronary system, bilateral ITA have demonstrated their superiority over all others grafts in terms of patency and survival benefit. Because the ideal BITA assembling has not yet been found, we have prospectively randomized two types of BITA configurations and evaluated the clinical, functional and angiographic outcome after 6 months and 3 years.
Methods: From 03/2003 to 08/2006, 1297 patients underwent isolated CABG in our institution. Of these, 481 patients met the inclusion criteria for randomization and 304 were randomized. BITA grafting was performed with a pedicled configuration in 147 patients and with a Y configuration in 152. Patients had a stress test twice a year. Angiographic follow-up was performed 6 months after surgery. The primary and secondary end point was respectively the MACE and the proportion of occluded ITA at follow-up angiography.
Results: More arterial anastomoses were performed in the BITA Y group than in the BITA ped (3.2 versus 2.4; p< 0.001). There were no significant differences between the 2 groups in terms of hospital events. Clinical follow-up is 100 % complete with a mean of 16±11 months. At follow-up there is no significant difference in MACCE rate between the 2 groups. Angiographic follow-up is 90% complete. 97% of the anastomosis in both groups were controled patent (p=0.96).
Conclusions: Excellent patency rates were achieved in both groups with no significant difference in terms of MACE or patency. Whether the higher number of ITA anastomosis in the Y group will translate in better long-term results remains to be established.
Comparison: Bilat. Intern. Thor. Artery Revasc. using Pedicled or Y Graft Configurations: Prospective Randomized Clinic, Function. & Angiographic Mid-Term Eval.David Glineur, Claude Hanet, Alain Poncelet, William D’hoore, Jean-Christophe Funken, Jean Rubay, Parla Astarci, Valerie Lacroix, Robert Verhelst, Pierre Yves Etienne, Philippe Noirhomme, Gebrine El Khoury
Cliniques Universitaires Saint-Luc, Bruxelles |