Internal thoracic artery grafts for the entire heart at a mean of 12 years.

BACKGROUND: There is consensus today that the long-term results of bypassing the left anterior descending artery with an internal thoracic artery (ITA) graft are superior to those of a saphenous vein graft. Our hypothesis for this study was that three-vessel revascularization with only ITA grafts would also give excellent results. METHODS: Using our previously described techniques to enhance the length of ITA grafts by skeletonization and high mediastinal mobilization, we were able to perform tension-free, three-vessel revascularization using only ITA grafts in 125 (83%) of a consecutive series of 150 patients with three-vessel occlusive coronary disease. We followed 100% of these 125 exclusive ITA graft patients (average of 3.9 anastomoses per patient) to their time of death (59; 47.2%) or current living status (66; 52.8%). RESULTS: Combined intraoperative graft flows averaged 225 mL/min. Of the 125 patients in this study (average age, 63.5 years), 121 (96.8%) lived beyond 40 days. Of these 121 patients, 55 (45%) died at a mean of 7 years postoperatively and 66 (55%) are still living at a mean of 12.1 years. Of these 121 patients, 112 (93%) had angina at baseline. Of these 112, 92 (85%) were angina free at a mean of 9.1 years postoperatively. Freedom from infarction was 100% at 5 years and 97% at 10 years. Freedom from reintervention was 90% at a mean of 9.8 years. CONCLUSIONS: Use of ITA grafts for three-vessel coronary revascularization provides excellent results and is both practical and appropriate for many patients.

Utilizing granulocyte colony-stimulating factor to enhance vascular graft endothelialization from circulating blood cells.

Cells in the blood circulating through a vascular graft can contribute to endothelialization of its flow surface. We hypothesized that granulocyte colony-stimulating factor (G-CSF) could enhance this process by increasing circulating bone marrow progenitor cells. Ten dogs received composite grafts that were shielded from any source of endothelialization other than the circulating blood. On the seventh postoperative day and for 7 days thereafter, five dogs were injected subcutaneously with 10 mg/kg/day of human G-CSF. The additional five dogs, used as controls, received no G-CSF. Grafts were retrieved at 4 weeks. All dogs recovered promptly postoperatively. White cell counts in G-CSF dogs increased by an average of 9.5-fold at the end of treatment, and had returned to normal before retrieval. All grafts remained patent. G-CSF grafts had significantly higher endothelialization than the controls (82.2 +/- 9.2% vs. 23.7 +/- 4.4%, p = 0.0004), with extensive flow surface neointima, covered with a single layer of endothelium verified by FVIII/vWF and CD34 staining. Control grafts had virtually no neointima and were covered with a thin layer of fibrin coagulum. Significantly more endothelial-lined microvessels were also found in the G-CSF grafts than in the controls. Dogs treated with G-CSF have increased endothelialization of synthetic vascular grafts due to increased circulating bone marrow progenitor cells.