Long-Term Outcome of Ultrasonic Scalpel Coronary Artery Bypass Grafting Using Bilateral Internal Thoracic Arteries

Akitatsu Yamashita	Satomi Inoue	Toshiyuki Maeda
Masaki Tabuchi

（Department of Thoracic and Cardiovascular Surgery, Hokkaido Prefectural Kitami Hospital, Kitami, Japan, Division of Acellular Tissue and Regenerative Medical Material, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University＊, Tokyo, Japan, and Department of Thoracic and Cardiovascular Surgery, Muroran City General Hospital＊＊, Muroran, Japan）

It seems obvious that artery grafts improve the long-term prognosis of coronary artery bypass grafting（CABG). Besides, the superiority of using bilateral ITAs compared with a single ITA has been reported. An ultrasonic scalpel was introduced in our hospital in April 2001, and since then, we have harvested bilateral ITAs with it in a full skeletonized fashion, and as a result, we have been using bilateral ITAs for CABG routinely. In this study, we reviewed the surgical outcomes in 256 patients who underwent CABG alone, using bilateral ITAs harvested with ultrasonic scalpel between April, 2001 and December, 2012. Of these patients, 194 underwent off-pump CABG（8 were converted to on-pump CABG), and 38 required emergency surgery. One patient died from cerebral infarction within 30 days after the operation. Of all 256 patients, 234 underwent graftograms within 2 weeks after surgery, and 10 patients（4.3%）needed re-intervention including redo CABG or PCI in the early stage. None of these suffered mediastinitis. We also studied long-term outcomes. The follow-up rate was 100% and the mean follow-up period was 2.97±2.6 years. The survival rate was 81.8%, and 72.6% at 5 years, and 10 years, respectively. The freedom from redo CABG was 99.5%, and 99.3% at 5 years, and 10 years, respectively. The freedom from PCI was 96.3%, and 95.2% at 5 years, and 10 years, respectively. The freedom from MACE was 90.3%, and 81.2% at 5 years, and 10 years, respectively. Bilateral ITAs harvested with an ultrasonic scalpel can be used for CABG safely and with satisfactory long-term results.

Jpn. J. Cardiovasc. Surg. 44:307-311（2015）

Keywords：CABG;ITA;skeletonization