Retroaortic right internal thoracic artery grafting of circumflex artery targets

BackgroundRetroaortic right internal thoracic artery grafting has failed to gain popularity. We aimed to delineate patient correlates of eligibility, distribution of targets, and effects of target remoteness on outcome and risk of retroaortic bleeding.MethodsData of 861 patients undergoing skeletonized bilateral internal thoracic artery grafting (2007–2012) were analyzed according to retroaortic (n = 300) or T-graft configuration. Retroaortic graft subgroups were categorized according to proximal (first obtuse marginal, ramus) or distal (2nd, 3rd, or sequential 1st-2nd obtuse marginal) circumflex artery targets.ResultsLOESS curve analyses revealed that taller patients had a higher likelihood of retroaortic grafting. The distribution of 337 retroaortic graft targets (300 patients) was first obtuse marginal in 74.5%, 2nd marginal in 12.4%, ramus in 11.2%, 3rd marginal in 1.9% and sequential 1st-2nd marginal in 12.3%. The success rate in reaching proximal and distal circumflex artery targets was 97% and 30%,...