Myocardial revascularization with bilateral internal thoracic artery in patients with left main disease or left ventricular dysfunction: an incremental risk?

Although long-term patency of the internal thoracic artery (ITA) is well stated, there is still some concern about its perioperative performance. We considered 122 consecutive patients, 63 with left main disease (LMD; mean age 60 years) and 59 with left ventricular dysfunction (LVD; mean age 59 years) who underwent coronary artery bypass grafting in our Institute from March 1988 to September 1992. Patients with LMD were divided into 2 groups: LMD I: 29 patients receiving only ITA grafts on the left coronary system and LMD II: 34 patients having a single ITA graft on the left coronary system. Patients with LVD were divided into: LVD I: 44 patients operated with bilateral ITA and LVD II: 15 patients receiving a single ITA graft. Perioperative complications in LMD I and LMD II patients were respectively: myocardial necrosis in 2 (6.9%) versus 3 (8.8%), use of intra-aortic balloon pump (IABP) in 2 (6.9%) versus 2 (5.9%); no death occurred in both groups. Perioperative results in groups LVD I and LVD II were: death in 1 patient (2.2%) versus 1 (6.7%), myocardial necrosis in 2 (4.5%) versus 1 (6.7%) and IABP in 4 (9.1%) versus 2 (13.3%). In our experience the use of bilateral ITA grafts in patients with LMD and LVD was not related to an incremental risk. We conclude that LMD and LVD should not be considered as contraindications to the extensive use of arterial conduits.