In situ skeletonized bilateral thoracic artery for left coronary circulation: a 20-year experience

Massimo Bonacchi*, Edvin Prifti, Marco Bugetti, Francesco Cabrucci, Michael Cresci, Fabiana Luca, Orlando Parise, Francesco Matteucci, Guido Sani, Daniel M. Johnson, Sandro Gelsomino

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVES: Our goal was to analyse the outcomes in a patient population using a standardized technique for coronary artery bypass grafting (CABG) consisting of total arterial myocardial revascularization utilizing the in situ skeletonized bilateral thoracic artery for left coronary circulation. We also explored potential predictors of long-time unfavourable outcomes.

METHODS: Patients undergoing total arterial myocardial revascularization using in situ skeletonized bilateral thoracic artery for left coronary circulation between January 1997 and May 2017 were included prospectively in this study. The median follow-up (100% complete) was 103 months (interquartile range 61-189 months) and ranged from 1 to 245 months.

RESULTS: A total of 1325 consecutive patients were recruited. During the follow-up period, there were 131 deaths (9.8%), 146 repeat revascularizations (11.0%) and 229 major adverse cardiac events (17.2%). The 18-year freedom from major adverse cardiac events was 62.69.3%, 62.5 +/- 6.3% and 53.9 +/- 11.0%, respectively. Multivariable models showed that a left ventricular ejection fraction = 80 years (P=0.002) were independent predictors of diminished long-term survival. Moreover, peripheral vascular disease and off-pump coronary artery bypass (both, P <0.001) predicted repeat revascularization. Finally, age >= 80 years, peripheral vascular disease, left ventricular ejection fraction

CONCLUSIONS: Coronary artery bypass using the in situ skeletonized bilateral thoracic artery for left coronary circulation configuration for total arterial myocardial revascularization resulted in satisfactory long-term results with a low incidence of death and late events and may represent a technique of choice in selected patients having CABG. Larger and long-term prospective studies are, however, warranted.

Original languageEnglish
Pages (from-to)160-167
Number of pages8
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number1
Publication statusPublished - Jan 2020


  • Internal thoracic artery
  • Arterial myocardial revascularization
  • Coronary artery bypass
  • FLOW

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