Sequential coronary artery bypass grafting utilizing the internal thoracic and gastroepiploic artery as in situ grafts

: 36 consecutive patients (male:female = 33:3, mean age 57.3) underwent sequential coronary artery bypass grafting (CABG) utilizing the left internal thoracic artery (LITA, n = 30), right gastroepiploic artery (RGEA, n = 8) as in situ grafts. Two patients received sequential bypass grafting with both grafts simultaneously. No right internal thoracic arteries were used except for one as a free nonsequential graft. Taking into account the adjunctive venous anastomoses and the arterial nonsequential anastomoses, there were 3.5 anastomoses per patients. Proxymal side-to-side anastomosis of LITAs were all constructed on the diagonal branches except for one on the proxymal Left Anterior Descending Coronary Artery (LAD), whereas that of the RGEAs were on the proxymal Right Coronary Artery (RCA) (2), distal RCA (6) or distal circumflex (1). Distal end-to-side anastomoses of LITAs were all on the LAD, and those of the RGEAs were on the distal RCA (3) or distal circumflex artery (5). Proxymal side-to-side anastomoses were always performed first, allowing us to assess the distal flow through the graft before we anastomose it to the distal branch. We routinely obtain a preoperative angiogram of the arterial grafts, which enable us to fully assess the suitability of the arteries as in situ grafts. There were no perioperative deaths, nor perioperative myocardial infarctions, however, two patients died of extracardiac causes at 42 and 68 days after operation respectively. For the thirty four survivors, followup was complete (4-49 months, average 12.3 months). One still had angina of Canadian Cardiovascular Society Classification (CCSC) class 2, and 33 were free of angina.(ABSTRACT TRUNCATED AT 250 WORDS)