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. 2024 Oct 18:11:1478166.
doi: 10.3389/fcvm.2024.1478166. eCollection 2024.

Improvement of the outcome of the saphenous vein graft when connected to the internal thoracic artery

Konstantinos Katsavrias  1 , Sotirios Prapas  1 , Antonio M Calafiore  1 , David Taggart  2 , Dimitrios Angouras  3 , Dimitrios Iliopoulos  3 , Michele Di Mauro  4   5 , Styliani Papandreopoulos  1 , Panayiotis Zografos  1 , Dimitrios Dougenis  3
Affiliations

Improvement of the outcome of the saphenous vein graft when connected to the internal thoracic artery

Konstantinos Katsavrias et al. Front Cardiovasc Med. .

Abstract

Background: Since 2000, we have been grafting the right coronary artery system (RCAs) using the proximal portion of the right internal thoracic artery (RITA) as the inflow of the saphenous vein graft (SVG) to increase the number of patients undergoing beating heart complete myocardial revascularization.

Methods: From 2000 to 2022, 928 consecutive patients underwent SVG on the RCAs. In 546 patients (58.8%), the inflow was the RITA (I-graft group), and in 382 patients (41.2%), the inflow was the aorta (Ao-graft group). The inclusion criteria were age ≤75 years, ejection fraction >35%, only one SVG per patient, bilateral internal thoracic arteries as a Y-graft on the left system (three-vessel disease, n = 817, 88.0%) or left internal thoracic artery on the left anterior descending artery and RITA + SVG on the RCAs (two-vessel disease, n = 111, 12.0%). Propensity matching identified 306 patients per group. After a median follow-up of 8 (5-10) years, graft patency was assessed by coronary computed tomographic angiography in 132 patients (64 in the I-graft group and 68 in the Ao-graft group).

Results: Early results were similar in both groups. The I-graft group had higher 10-year survival and freedom from main adverse cardiac events (90.0 ± 2.0 vs. 80.6 ± 3.8, p = 0.0162, and 81.3 ± 2.7 vs. 64.7 ± 5.6, p = 0.0206, respectively). When RITA was the inflow, SVG had a higher estimated 10-year patency rate (82.8% ± 6.5 vs. 58.8% ± 7.4, p = 0.0026) and a smaller inner lumen diameter (2.7 ± 0.4 vs. 3.4 ± 0.6 mm, p < 0.0001).

Conclusion: When the inflow is the RITA, SVG grafted to the RCAs (I-graft) may result in a higher patency rate and better outcome than when the inflow is the ascending aorta (Ao-graft). The continuous supply of nitric oxide by RITA may be the cause of the higher patency rate of the I-graft, which can behave like an arterial conduit.

Keywords: I-graft; OPCAB; anaortic bypass; composite graft; saphenous vein graft.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Freedom from death of any cause in the two propensity-matched groups. HR, hazard ratio; CI, confidence interval.
Figure 2
Figure 2
Freedom from MACE in the two propensity-matched groups. MACE, main adverse cardiac events; HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
CCTA after I-graft RITA-SVG distally anastomosed to PDA. The diameter of the SVG has with time the trend to become equal to that of RITA. (A) After 123 months the size of the SVG is similar to that of RITA. (B) After 138 months the size of the SVG is still slightly larger than the RITA. CCTA, computed coronary tomographic angiography; RITA, right internal thoracic artery; SVG, saphenous vein graft; PDA, posterior descending artery.
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