Bilateral Internal Mammary Grafts With Preservation of Sternum Blood Supply

: We have prospectively collected data from 43 patients who underwent coronary artery bypass surgery and received bilateral internal thoracic artery (ITA) graft. Left ITA was harvested on full length from ostium to bifurcation. Right ITA harvesting included mobilization of only its proximal stump (5-6 cm long), that allowed its distal segment to remain intact. Proximal stump of right ITA was lengthened by radial artery or large subcutaneous vein grafts in order to reach various parts of coronary vascular bed. After comparative intraoperative manometry of ante- and retrograde pressures in right ITA patients were divided into two groups. In group 1patients (n=28) difference between ante- and retrograde systolic pressure (112.5+/-17.4 and 92.4+/-19.6 mm Hg, respectively) was 60-70%) were more frequent in group 2 (n=8; 18.6%) than in group 1 (n=4; 9%). However postoperative ultrasound study detected no significant differences between two groups in systolic retrograde blood flow velocity in intact portion of right ITA (29.8+/-8.7 and 23.1+/-8.0 cm/s, respectively, p>0.05). Absence of sternal wound healing complications confirmed efficacy of sternal retrograde blood supply through lower and upper epigastric arteries. Patency rate of composite grafts according to angiography (n=19) performed in 3+/-0.8 years after surgery was high (94.7%). Our data confirm high functionality of bilateral ITA grafts with preservation of sternal supply.