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Ki Bong Kim - One of the best experts on this subject based on the ideXlab platform.
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right gastroepiploic artery versus right internal thoracic artery composite grafts 10 year patency and long term outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Minseok Kim, Ho Young Hwang, Kwang Ree Cho, Ki Bong KimAbstract:Abstract Objectives We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (Rita) composite grafts. Methods From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or Rita (Rita group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the Rita group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months. Results The early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and Rita groups, 10.3% and 8.4%, respectively; P = .639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and Rita groups (14.1% and 10.2%, respectively; P = .487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P = .470), cardiac mortality-free survival (92.1% vs 90.9%; P = .560), freedom from target vessel revascularization (83.0% vs 91.4%; P = .230), freedom from reintervention (68.8% vs 76.2%; P = .731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P = .364) rates between the matched groups. Conclusions Total arterial revascularization using RGEA composite grafts showed comparable results to those using Rita composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y composite graft save Rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ki Bong Kim, Ho Young Hwang, Seokyung Hahn, Jun Sung KimAbstract:Objective The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE Rita) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-composite graft. Methods A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or Rita as a Y-composite graft based on the in situ left ITA were assigned randomly to the SV Y-composite graft (SV group, n = 112) or free Rita Y-composite graft (Rita group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or Rita). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; Rita group, 107). Results The overall graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the Rita group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV composite grafts, was 97.1% (238 of 245) and was noninferior to that of the Rita composite grafts (97.1% [198 of 204]) with a 95% lower confidence limit of −2.6% ( P P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years ( P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years ( P = .597). Conclusions The SV composite grafts were noninferior to the Rita composite grafts in terms of the 1-year angiographic patency rates.
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equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts five year outcomes
The Annals of Thoracic Surgery, 2013Co-Authors: Ho Young Hwang, Kwang Ree Cho, Ki Bong KimAbstract:Background We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (Rita) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. Methods Of 443 patients who underwent off-pump coronary revascularization exclusively using arterial Y-composite grafts, the Rita (n = 114) or RGEA (n = 329) was anastomosed to the side of the in situ left internal thoracic artery. A propensity score-matched analysis was used to match patients using the Rita (Rita group, n = 105) with patients using the RGEA (RGEA group, n = 105). Five-year angiographic patency rates and long-term clinical outcomes were compared. Results There were no differences in early mortality and postoperative complication rates between the Rita and RGEA groups. Five-year postoperative angiography showed no significant differences in overall graft patency (95.0% versus 95.1%; p = 0.895) and second-limb conduit patency (Rita versus RGEA, 93.4% versus 92.1%; p = 0.704) rates between the two groups. Propensity score-adjusted multivariable analysis revealed that previous history of percutaneous coronary intervention was the only significant risk factor for second-limb conduit occlusion at 5 years postoperatively ( p = 0.003). No differences in overall survival ( p = 0.703) and freedom from cardiac death ( p = 0.968) rates were observed between the two groups. Reintervention-free survival ( p = 0.236) and major adverse cardiac and cerebrovascular event-free survival ( p = 0.704) rates were also similar between the two groups. Conclusions Total arterial revascularization using Rita and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes.
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comparison of right internal thoracic artery and right gastroepiploic artery y grafts anastomosed to the left internal thoracic artery
The Annals of Thoracic Surgery, 2010Co-Authors: Kwang Ree Cho, Ho Young Hwang, Jun Sung Kim, Dong Seop Jeong, Ki Bong KimAbstract:Background Early and 1-year results of arterial Y composite grafts anastomosed to the in situ left internal thoracic artery were studied. Methods Three hundred twelve patients who underwent off-pump coronary artery bypass using arterial Y composite grafts for revascularization of the left coronary artery territory were analyzed. A skeletonized right internal thoracic artery (Rita) or right gastroepiploic artery (RGEA) was anastomosed to the side of the left internal thoracic artery to construct a Y composite graft. Propensity-matched analysis was used to match patients using Rita (Rita group, n=102) with patients using RGEA (RGEA group, n=102). Postoperative coronary angiographies were performed early (200 of 204; 1.8 ± 1.7 days) and 1 year (171 of 204, 11.3 ± 2.5 months) postoperatively. Results There were no differences in postoperative mortalities (1 of 102 versus 2 of 102; p = 1.000) and morbidities including atrial fibrillation, mediastinitis, and perioperative myocardial infarction between the Rita and RGEA groups (not significant). Early and 1-year postoperative angiographies showed that there were no significant differences in patency rate between the two groups (early, 99.4% versus 99.3%; p = 1.000; 1-year, 95.4% versus 97.4%; p = 0.251). When the early and 1-year patency rates were compared based on the side-arm graft used, there were no differences in patency rates of Rita versus RGEA grafts between the two groups (early, 99.4% versus 100%; p = 1.000; 1-year, 96.5% versus 97.7%; p = 0.724). Conclusions Construction of Y composite grafts using the Rita or RGEA showed comparable results including patency rates early and 1 year postoperatively.
Ho Young Hwang - One of the best experts on this subject based on the ideXlab platform.
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right gastroepiploic artery versus right internal thoracic artery composite grafts 10 year patency and long term outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Minseok Kim, Ho Young Hwang, Kwang Ree Cho, Ki Bong KimAbstract:Abstract Objectives We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (Rita) composite grafts. Methods From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or Rita (Rita group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the Rita group (n = 152). The 10-year angiographic occlusion rates and long-term clinical outcomes were compared. The follow-up data were complete for all 304 patients (100%) with a median follow-up of 143.7 months. Results The early clinical outcomes were similar between the matched groups. The overall graft occlusion rate was 9.5% at 10 years in the matched group patients (matched RGEA and Rita groups, 10.3% and 8.4%, respectively; P = .639). The 10-year occlusion rates of the second-limb conduits showed no differences between the matched RGEA and Rita groups (14.1% and 10.2%, respectively; P = .487). No statistically significant differences were found at 15 years postoperatively in the overall survival (52.9% vs 49.4%; P = .470), cardiac mortality-free survival (92.1% vs 90.9%; P = .560), freedom from target vessel revascularization (83.0% vs 91.4%; P = .230), freedom from reintervention (68.8% vs 76.2%; P = .731), or freedom from major adverse cardiac and cerebrovascular events (56.4% vs 64.6%; P = .364) rates between the matched groups. Conclusions Total arterial revascularization using RGEA composite grafts showed comparable results to those using Rita composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y composite graft save Rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ki Bong Kim, Ho Young Hwang, Seokyung Hahn, Jun Sung KimAbstract:Objective The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE Rita) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-composite graft. Methods A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or Rita as a Y-composite graft based on the in situ left ITA were assigned randomly to the SV Y-composite graft (SV group, n = 112) or free Rita Y-composite graft (Rita group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or Rita). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; Rita group, 107). Results The overall graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the Rita group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV composite grafts, was 97.1% (238 of 245) and was noninferior to that of the Rita composite grafts (97.1% [198 of 204]) with a 95% lower confidence limit of −2.6% ( P P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years ( P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years ( P = .597). Conclusions The SV composite grafts were noninferior to the Rita composite grafts in terms of the 1-year angiographic patency rates.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y composite graft save Rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ho Young Hwang, Seokyung Hahn, Se Jin OhAbstract:OBJECTIVE: The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE Rita) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-composite graft. METHODS: A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or Rita as a Y-composite graft based on the in situ left ITA were assigned randomly to the SV Y-composite graft (SV group, n = 112) or free Rita Y-composite graft (Rita group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or Rita). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; Rita group, 107). RESULTS: The overall graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the Rita group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV composite grafts, was 97.1% (238 of 245) and was noninferior to that of the Rita composite grafts (97.1% [198 of 204]) with a 95% lower confidence limit of -2.6% (P < .001 for noninferiority). The graft qualities, evaluated using the FitzGibbon patency grades, were also similar between the 2 groups (P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years (P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years (P = .597). CONCLUSIONS: The SV composite grafts were noninferior to the Rita composite grafts in terms of the 1-year angiographic patency rates.
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equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts five year outcomes
The Annals of Thoracic Surgery, 2013Co-Authors: Ho Young Hwang, Kwang Ree Cho, Ki Bong KimAbstract:Background We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (Rita) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. Methods Of 443 patients who underwent off-pump coronary revascularization exclusively using arterial Y-composite grafts, the Rita (n = 114) or RGEA (n = 329) was anastomosed to the side of the in situ left internal thoracic artery. A propensity score-matched analysis was used to match patients using the Rita (Rita group, n = 105) with patients using the RGEA (RGEA group, n = 105). Five-year angiographic patency rates and long-term clinical outcomes were compared. Results There were no differences in early mortality and postoperative complication rates between the Rita and RGEA groups. Five-year postoperative angiography showed no significant differences in overall graft patency (95.0% versus 95.1%; p = 0.895) and second-limb conduit patency (Rita versus RGEA, 93.4% versus 92.1%; p = 0.704) rates between the two groups. Propensity score-adjusted multivariable analysis revealed that previous history of percutaneous coronary intervention was the only significant risk factor for second-limb conduit occlusion at 5 years postoperatively ( p = 0.003). No differences in overall survival ( p = 0.703) and freedom from cardiac death ( p = 0.968) rates were observed between the two groups. Reintervention-free survival ( p = 0.236) and major adverse cardiac and cerebrovascular event-free survival ( p = 0.704) rates were also similar between the two groups. Conclusions Total arterial revascularization using Rita and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes.
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comparison of right internal thoracic artery and right gastroepiploic artery y grafts anastomosed to the left internal thoracic artery
The Annals of Thoracic Surgery, 2010Co-Authors: Kwang Ree Cho, Ho Young Hwang, Jun Sung Kim, Dong Seop Jeong, Ki Bong KimAbstract:Background Early and 1-year results of arterial Y composite grafts anastomosed to the in situ left internal thoracic artery were studied. Methods Three hundred twelve patients who underwent off-pump coronary artery bypass using arterial Y composite grafts for revascularization of the left coronary artery territory were analyzed. A skeletonized right internal thoracic artery (Rita) or right gastroepiploic artery (RGEA) was anastomosed to the side of the left internal thoracic artery to construct a Y composite graft. Propensity-matched analysis was used to match patients using Rita (Rita group, n=102) with patients using RGEA (RGEA group, n=102). Postoperative coronary angiographies were performed early (200 of 204; 1.8 ± 1.7 days) and 1 year (171 of 204, 11.3 ± 2.5 months) postoperatively. Results There were no differences in postoperative mortalities (1 of 102 versus 2 of 102; p = 1.000) and morbidities including atrial fibrillation, mediastinitis, and perioperative myocardial infarction between the Rita and RGEA groups (not significant). Early and 1-year postoperative angiographies showed that there were no significant differences in patency rate between the two groups (early, 99.4% versus 99.3%; p = 1.000; 1-year, 95.4% versus 97.4%; p = 0.251). When the early and 1-year patency rates were compared based on the side-arm graft used, there were no differences in patency rates of Rita versus RGEA grafts between the two groups (early, 99.4% versus 100%; p = 1.000; 1-year, 96.5% versus 97.7%; p = 0.724). Conclusions Construction of Y composite grafts using the Rita or RGEA showed comparable results including patency rates early and 1 year postoperatively.
John A. Fuller - One of the best experts on this subject based on the ideXlab platform.
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the right internal thoracic artery is it underutilized
Current Opinion in Cardiology, 2011Co-Authors: James Tatoulis, Brian F Buxton, John A. FullerAbstract:Purpose of reviewThe left internal thoracic artery is acknowledged as the best coronary conduit. The right internal thoracic artery (Rita) is identical to the left ITA (LITA), yet, despite excellent published results, the Rita [as part of bilateral ITA (BITA) grafting] is rarely used in coronary art
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the right internal thoracic artery the forgotten conduit 5 766 patients and 991 angiograms
The Annals of Thoracic Surgery, 2011Co-Authors: James Tatoulis, Brian F Buxton, John A. FullerAbstract:BACKGROUND: The right internal thoracic artery (Rita) is biologically identical to the left ITA, yet is rarely used in coronary artery bypass graft surgery (CABG). We examined the results and long-term patency of Rita grafts. METHODS: Between 1986 and 2008, 991 consecutive Rita graft angiograms for postoperative cardiac symptoms were evaluated by two independent observers. Grafts were considered nonpatent if they had a greater than 80% stenosis, string sign, or total occlusion. Patency was examined over time by coronary territory, whether in situ or free Rita, and compared with other conduits. Clinical results were collected prospectively and by the National Death Index. RESULTS: A total of 5,766 patients had a Rita graft as part of a bilateral ITA CABG procedure. Operative mortality was 1.1%; deep sternal infection 1.5%. Of 7,780 coronary conduits studied, 991 Rita conduits were examined; a mean of 100±60 months postoperatively (1 to 288 months). Overall ten-year Rita patency was 90%. The Rita graft patency to the left anterior descending artery (LAD; n=149) was 95% at 10 years and 90% at 15 years. Ten-year Rita patency to the circumflex marginal (Cx; n=436) was 91%, right coronary artery (n=199) was 84% (p<0.001), and posterior descending artery (n=207) was 86%. Ten-year Rita and LITA patencies to the LAD were identical (95% vs 96%) and to the Cx (91% vs 89%), respectively. In situ Rita (n=450) and free Rita (n=541) had similar ten-year patencies (89% vs 91%; p=0.44). The Rita patency was always better than the radial artery (p<0.01) and saphenous vein grafts (p<0.001). Atheromatous changes were not seen in the Rita angiograms. Ten-year survival of patients with Rita and LITA for triple-vessel coronary disease was 89%. CONCLUSIONS: Late patencies of Rita are excellent, equivalent to the LITA for identical territories, always better than radial arteries and saphenous vein grafts, and remain free of atheroma. Use of Rita in addition to LITA is associated with excellent survival in triple-vessel coronary disease. More extensive use of the Rita in CABG is recommended.
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factors affecting patency of internal thoracic artery graft clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 2002
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: Pallav Shah, James Tatoulis, John A. Fuller, Alexander Rosalion, Manoj Durairaj, Ian Gordon, Siven Seevanayagam, Brian F BuxtonAbstract:OBJECTIVE: The purpose is to define factors influencing long-term patency of the internal thoracic artery (ITA) to optimize the operative strategy. METHODS: 1482 left internal thoracic artery (LITA) and 636 right internal thoracic artery (Rita) symptom-directed angiograms were studied in 1434 patients. Data were prospectively collected from patients who had primary coronary artery bypass surgery during the period 1982-2002. The mean age of patients was 59 years; 85% were male. The mean period from operation to re-angiogram was 80 months. LITA was grafted to left anterior descending coronary artery (LAD) in 82% of cases, Rita to right coronary artery (RCA) in 40% and circumflex artery in 35% of cases. Graft failure was defined as > or =80% stenosis. RESULTS: 96.3% of LITA and 88.1% of Rita grafts were patent. No patient variables were significantly associated with graft patency (age, gender, diabetes, hypertension, LVEF, NYHA, AMI). Target coronary artery was associated with patency of both LITA and Rita grafts with maximum patency when grafted to LAD (P = 0.02) Rita had the worst patency to RCA, patency for the left system was identical to LITA. Proximal anastomosis to aorta (free Rita) had significantly better patency when compared with in situ Rita to RCA system (P = 0.005) while similar patency when grafted to left system. ITA diameter and target artery diameter were not associated with graft patency. Recent operations had better Rita patency (P = 0.03). The interval from operation to angiogram was not associated with ITA patency (96% patency for LITA and 88% patency for Rita, remained stable when studied at 15 years). CONCLUSIONS: Even in a patient cohort that had adverse symptoms, excellent LITA and Rita patency was achieved which almost remained constant through all time intervals studied.
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the right internal thoracic artery graft benefits of grafting the left coronary system and native vessels with a high grade stenosis
European Journal of Cardio-Thoracic Surgery, 2000Co-Authors: Brian F Buxton, John A. Fuller, Permyos Ruengsakulrach, Alexander Rosalion, Christopher M Reid, James TatoulisAbstract:Objective: The left internal thoracic artery (LITA), when grafted to the left anterior descending artery (LAD), is generally accepted as the conduit of choice for coronary artery bypass grafting (CABG). In contrast, the role and efficacy of the right internal thoracic artery (Rita), despite its long-term use as a coronary artery graft, is relatively less understood. Accordingly, in this study, we sought to assess the utility of the Rita as a coronary conduit by examining the long-term patency of both in situ and free Rita grafts and analyzing the association between intraoperative graft and coronary artery variables. Methods: Nine hundred and sixty-two patients (LITA 962, Rita 432) who had CABG between 1985 and 1998 and underwent re-angiography for evidence of myocardial ischemia were included in this observational analysis. The diameter of the internal thoracic artery (ITA), the presence of a proximal anastomosis with the aorta, the location of the anastomosis with the coronary artery, and the coronary artery diameter, were recorded at the initial procedure. The follow-up was 67.0 ^ 39.4 months (mean ^ SD, range 0.1‐169.5). The relationship between intraoperative variables and graft patency was assessed using Cox proportional hazard models. Results: Highest Rita failure rates were associated with grafting a native coronary artery with a stenosis of less than 60% compared with 80‐100% (RR 3.8 (95% CI, 1.9‐7.2) Pa 0:0001). Grafts to non-LAD arteries had a higher risk of failure, the highest risk ratio being associated with grafting the right coronary artery (RR 4.0 (95% CI, 0.9‐17.4) Pa 0:06)). Free compared with in situ grafts were also associated with a higher risk of failure with this result bordering on statistical significance (RR 1.9 (95% CI, 1.0‐ 6.0) Pa 0:06)) Conclusion: Preference should be given to grafting arteries with a high grade stenosis or occlusion, to grafting left rather than right coronary arteries, and to using in situ rather than free ITA grafts. Passing the Rita to the left, either anterior to the aorta or through the transverse sinus, did not influence patency. q 2000 Elsevier Science B.V. All rights reserved.
James Tatoulis - One of the best experts on this subject based on the ideXlab platform.
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the right internal thoracic artery is it underutilized
Current Opinion in Cardiology, 2011Co-Authors: James Tatoulis, Brian F Buxton, John A. FullerAbstract:Purpose of reviewThe left internal thoracic artery is acknowledged as the best coronary conduit. The right internal thoracic artery (Rita) is identical to the left ITA (LITA), yet, despite excellent published results, the Rita [as part of bilateral ITA (BITA) grafting] is rarely used in coronary art
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the right internal thoracic artery the forgotten conduit 5 766 patients and 991 angiograms
The Annals of Thoracic Surgery, 2011Co-Authors: James Tatoulis, Brian F Buxton, John A. FullerAbstract:BACKGROUND: The right internal thoracic artery (Rita) is biologically identical to the left ITA, yet is rarely used in coronary artery bypass graft surgery (CABG). We examined the results and long-term patency of Rita grafts. METHODS: Between 1986 and 2008, 991 consecutive Rita graft angiograms for postoperative cardiac symptoms were evaluated by two independent observers. Grafts were considered nonpatent if they had a greater than 80% stenosis, string sign, or total occlusion. Patency was examined over time by coronary territory, whether in situ or free Rita, and compared with other conduits. Clinical results were collected prospectively and by the National Death Index. RESULTS: A total of 5,766 patients had a Rita graft as part of a bilateral ITA CABG procedure. Operative mortality was 1.1%; deep sternal infection 1.5%. Of 7,780 coronary conduits studied, 991 Rita conduits were examined; a mean of 100±60 months postoperatively (1 to 288 months). Overall ten-year Rita patency was 90%. The Rita graft patency to the left anterior descending artery (LAD; n=149) was 95% at 10 years and 90% at 15 years. Ten-year Rita patency to the circumflex marginal (Cx; n=436) was 91%, right coronary artery (n=199) was 84% (p<0.001), and posterior descending artery (n=207) was 86%. Ten-year Rita and LITA patencies to the LAD were identical (95% vs 96%) and to the Cx (91% vs 89%), respectively. In situ Rita (n=450) and free Rita (n=541) had similar ten-year patencies (89% vs 91%; p=0.44). The Rita patency was always better than the radial artery (p<0.01) and saphenous vein grafts (p<0.001). Atheromatous changes were not seen in the Rita angiograms. Ten-year survival of patients with Rita and LITA for triple-vessel coronary disease was 89%. CONCLUSIONS: Late patencies of Rita are excellent, equivalent to the LITA for identical territories, always better than radial arteries and saphenous vein grafts, and remain free of atheroma. Use of Rita in addition to LITA is associated with excellent survival in triple-vessel coronary disease. More extensive use of the Rita in CABG is recommended.
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factors affecting patency of internal thoracic artery graft clinical and angiographic study in 1434 symptomatic patients operated between 1982 and 2002
European Journal of Cardio-Thoracic Surgery, 2004Co-Authors: Pallav Shah, James Tatoulis, John A. Fuller, Alexander Rosalion, Manoj Durairaj, Ian Gordon, Siven Seevanayagam, Brian F BuxtonAbstract:OBJECTIVE: The purpose is to define factors influencing long-term patency of the internal thoracic artery (ITA) to optimize the operative strategy. METHODS: 1482 left internal thoracic artery (LITA) and 636 right internal thoracic artery (Rita) symptom-directed angiograms were studied in 1434 patients. Data were prospectively collected from patients who had primary coronary artery bypass surgery during the period 1982-2002. The mean age of patients was 59 years; 85% were male. The mean period from operation to re-angiogram was 80 months. LITA was grafted to left anterior descending coronary artery (LAD) in 82% of cases, Rita to right coronary artery (RCA) in 40% and circumflex artery in 35% of cases. Graft failure was defined as > or =80% stenosis. RESULTS: 96.3% of LITA and 88.1% of Rita grafts were patent. No patient variables were significantly associated with graft patency (age, gender, diabetes, hypertension, LVEF, NYHA, AMI). Target coronary artery was associated with patency of both LITA and Rita grafts with maximum patency when grafted to LAD (P = 0.02) Rita had the worst patency to RCA, patency for the left system was identical to LITA. Proximal anastomosis to aorta (free Rita) had significantly better patency when compared with in situ Rita to RCA system (P = 0.005) while similar patency when grafted to left system. ITA diameter and target artery diameter were not associated with graft patency. Recent operations had better Rita patency (P = 0.03). The interval from operation to angiogram was not associated with ITA patency (96% patency for LITA and 88% patency for Rita, remained stable when studied at 15 years). CONCLUSIONS: Even in a patient cohort that had adverse symptoms, excellent LITA and Rita patency was achieved which almost remained constant through all time intervals studied.
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the right internal thoracic artery graft benefits of grafting the left coronary system and native vessels with a high grade stenosis
European Journal of Cardio-Thoracic Surgery, 2000Co-Authors: Brian F Buxton, John A. Fuller, Permyos Ruengsakulrach, Alexander Rosalion, Christopher M Reid, James TatoulisAbstract:Objective: The left internal thoracic artery (LITA), when grafted to the left anterior descending artery (LAD), is generally accepted as the conduit of choice for coronary artery bypass grafting (CABG). In contrast, the role and efficacy of the right internal thoracic artery (Rita), despite its long-term use as a coronary artery graft, is relatively less understood. Accordingly, in this study, we sought to assess the utility of the Rita as a coronary conduit by examining the long-term patency of both in situ and free Rita grafts and analyzing the association between intraoperative graft and coronary artery variables. Methods: Nine hundred and sixty-two patients (LITA 962, Rita 432) who had CABG between 1985 and 1998 and underwent re-angiography for evidence of myocardial ischemia were included in this observational analysis. The diameter of the internal thoracic artery (ITA), the presence of a proximal anastomosis with the aorta, the location of the anastomosis with the coronary artery, and the coronary artery diameter, were recorded at the initial procedure. The follow-up was 67.0 ^ 39.4 months (mean ^ SD, range 0.1‐169.5). The relationship between intraoperative variables and graft patency was assessed using Cox proportional hazard models. Results: Highest Rita failure rates were associated with grafting a native coronary artery with a stenosis of less than 60% compared with 80‐100% (RR 3.8 (95% CI, 1.9‐7.2) Pa 0:0001). Grafts to non-LAD arteries had a higher risk of failure, the highest risk ratio being associated with grafting the right coronary artery (RR 4.0 (95% CI, 0.9‐17.4) Pa 0:06)). Free compared with in situ grafts were also associated with a higher risk of failure with this result bordering on statistical significance (RR 1.9 (95% CI, 1.0‐ 6.0) Pa 0:06)) Conclusion: Preference should be given to grafting arteries with a high grade stenosis or occlusion, to grafting left rather than right coronary arteries, and to using in situ rather than free ITA grafts. Passing the Rita to the left, either anterior to the aorta or through the transverse sinus, did not influence patency. q 2000 Elsevier Science B.V. All rights reserved.
Umberto Benedetto - One of the best experts on this subject based on the ideXlab platform.
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is the right internal thoracic artery superior to saphenous vein for grafting the right coronary artery a propensity score based analysis
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Umberto Benedetto, Massimo Caputo, Mario Gaudino, Alan J Bryan, Giovanni Mariscalco, Gianni D AngeliniAbstract:Abstract Objectives Although the use of the right internal thoracic artery (Rita) as second arterial conduit to graft the left coronary system consistently has been shown to provide a survival benefit compared with the saphenous vein graft (SVG), the choice of conduit for the right coronary artery (RCA) system remains controversial. We compared long-term (>15 years) survival in patients who underwent Rita-RCA versus SVG-RCA grafting at a single institution. Methods The study population consisted of 7223 patients undergoing coronary artery bypass graft surgery. Of them 245 (3.4%) and 6978 (96.6%) received Rita-RCA and SVG-RCA graft, respectively. Propensity score matching and time-segmented Cox regression were used to compare the 2 groups. Results Survival probability at 5, 10, and 15 years were 95.9% (95% confidence interval [CI], 93.4-98.4) versus 96.0% (95% CI, 94.3-97.8), 89.8% (95% CI, 85.9-93.7) versus 88.0% (95% CI, 85.0-91.0) and 82.9% (95% CI, 77.6-88.2) versus 76.3 (95% CI, 72.0-80.5) in the Rita-RCA and SVG-RCA group, respectively. Time-segmented Cox regression showed that during the first 9 years, the 2 strategies were associated with comparable risk of death (hazard ratio, 1.13; 95% confidence interval, 0.67-1.90; P = .65) but beyond 9 years, the Rita-RCA was associated with a significantly lower risk of death (hazard ratio, 0.43; 95% confidence interval, 0.22-0.84; P = .01). Conclusions Revascularization of the RCA system with the Rita was associated with superior late survival compared with SVG. This supports the view that, the use of Rita to graft the RCA should be encouraged, especially in patients with long life expectancy.
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right internal thoracic artery or radial artery a propensity matched comparison on the second best arterial conduit
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Massimo Caputo, Umberto Benedetto, Mario Gaudino, Roberto Marsico, Cha Rajakaruna, Alan J Bryan, Gianni D AngeliniAbstract:Abstract Objectives We conducted propensity score matching to determine whether the use of the right internal thoracic artery (Rita) confers a survival advantage when compared with the radial artery (RA) as second arterial conduit in coronary artery bypass grafting. Methods The study population included a highly selected low-risk group of patients who received the Rita (n = 764) or the RA (n = 1990) as second arterial conduit. We obtained 764 matched pairs that were comparable for all pretreatment variables. A time-segmented Cox regression model that stratified on the matched pairs was used to investigate the effect of treatment on late mortality. Results After a mean follow-up of 10.2 ± 4.5 years (maximum 17.3 years), survival probabilities at 5, 10, and 15 years were 96.4% ± 0.7% versus 95.4% ± 0.7%, 91.0% ± 1.1% versus 89.1% ± 1.2%, and 82.4% ± 1.9% versus 77.2% ± 2.5% in the Rita and RA groups, respectively. During the first 4 years, Rita and RA were comparable in terms of mortality (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.56-1.78; P = .98). However, after 4 years Rita was associated with a significant reduction in late mortality (HR, 0.67; 95% CI, 0.48-0.95; P = .02). Rita was superior to RA when the experimental conduit was used to graft the left coronary system (HR, 0.69; 95% CI, 0.47-0.99; P = .04) but not the right coronary system (HR, 0.98; 95% CI, 0.59-1.62; P = .93). Conclusions In a highly selected low-risk group of patients, the use of the Rita as second arterial conduit instead of the RA was associated with better survival when used to graft the left but not the right coronary artery.
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right internal thoracic artery versus radial artery as the second best arterial conduit insights from a meta analysis of propensity matched data on long term survival
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Umberto Benedetto, Massimo Caputo, Mario Gaudino, Robert F Tranbaugh, Antonino Di Franco, Colin Ng, Leonard N Girardi, Gianni D AngeliniAbstract:Abstract Objective(s) We conducted a meta-analysis of propensity score-matching (PSM) studies comparing long-term survival of patients receiving right internal thoracic artery (Rita) versus radial artery (RA) as a second arterial conduit for coronary artery bypass grafting. Methods A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Primary endpoint was long-term mortality. Secondary endpoints were operative mortality, incidence of sternal wound infection, and repeat revascularization. Binary events were pooled using the DerSimonian and Laird method. For time-to-event outcomes, estimates of log hazard ratio (HR) and standard errors obtained were combined using the generic inverse-variance method. Results A total of 8 PSM studies were finally selected including 15,374 patients (Rita, 6739; RA, 8635) with 2992 matched pairs for final comparison. Mean follow-up time ranged from 45 to 168 months. When compared with RA, Rita was associated with a lower risk reduction of late death (HR, 0.75; 95% confidence interval [CI], 0.58-0.97; P = .028) and repeat revascularization (HR, 0.37; 95% CI, 0.16-0.85; P = .03). On the other hand, Rita did not increase operative mortality (odds ratio [OR], 1.53; 95% CI, 0.97-2.39; P = .07). Rita was associated with an increased risk of sternal wound complication when pedicled harvesting was used (OR, 3.18; 95% CI, 1.34-7.57), but not with skeletonized harvesting (OR, 1.07; 95% CI, 0.67-1.71). Conclusions The present PSM data meta-analysis suggests that the use of Rita compared with RA was associated with superior long-term survival and freedom from repeat revascularization, with similar operative mortality and incidence of sternal wound complication when the skeletonized harvesting technique was used.
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does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Shahzad G Raja, Umberto Benedetto, Mubassher Husain, Rafik F B Soliman, Fabio De Robertis, Mohamed AmraniAbstract:Background Despite their well-established advantages, bilateral internal thoracic arteries (BITA) are still largely underused. This is partly because of the technical complexities associated with the use of the right internal thoracic artery (Rita) to guarantee the universally accepted gold standard left internal thoracic artery (LITA) to left anterior descending artery (LAD) graft. The use of the in situ Rita for LAD grafting is a less technically demanding strategy. The impact of this strategy on early and late outcomes is investigated in the context of BITA usage. Methods Among 1667 patients undergoing first-time isolated coronary artery bypass grafting using BITA, in situ Rita for LAD grafting was used in 546 patients compared with in situ LITA to LAD in 1121 patients. Propensity score matching was carried out to investigate the impact of in situ Rita to LAD on early and late outcomes including mortality and need for repeat revascularization. Results A total of 546 propensity matched pairs were available for comparison. In the propensity matched cohort, the mean follow-up time was 7.8 ± 3.8 years. Rita to LAD did not increase the risk for late death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.48-1.26), the need for repeat revascularization (HR, 0.83; 95% CI, 0.70-2.42), and the composite of death or repeat revascularization (HR, 0.81; 95% CI, 0.64-1.14). Conclusions Using in situ BITA with retrosternal in situ Rita for LAD grafting is a technically less demanding, safe, and effective strategy that can increase usage of BITA by avoiding a composite graft configuration or technically challenging retrocaval routing of in situ Rita through the transverse sinus.
