Total Arterial Coronary Revascularization. Techniques, Results and Four Year Follow-up in Results and Four Year Follow-Up in 1023 Consecutive Patients

pp 69-77

Abstract

Background

The main objective of the present study was to analyze the in-hospital and mid-term results obtained in patients undergoing coronary artery by-pass surgery (CABG) in whom a combination of arterial grafts was used: radial arteries (RA) and one or both internal mammary arteries (IMA).

Methods

Between May 1995 and May 1998, 1,023 consecutive patients underwent CABG alone, using arterial conduits (AC) (one or two IMA and RA) for myocardial revascularization. The left internal mammary artery (LIMA) was employed as in situ graft, and the right internal mammary artery (RIMA) as a free graft or in situ both in combination with the RA. The latter was connected to the LIMA through a T or Y anastomosis, or emerged directly from the ascending aorta.

Results

An average of 3.3 bypasses per patient were done. The LIMA was used in 100% of the patients. The RIMA was used in 21.7% and the RA in 100% of the cases. Operative mortality was 2.5% (26 patients) and 32 (3.1%) suffered perioperative acute myocardial infarction (AMI). The first 62 patients were angiographically re-studied before discharge, and a 98.4% patency of the AC used was found.Mean follow-up time was 25.0 ± 9.6 months (range1-48 months).

Conclusions

According to the outcome of the patients we concluded that: 1) myocardial revascularization procedures using a combination of mammary and RA grafts are safe, 2) in-hospital and midterm morbidity and mortality are not higher than those ob-served with saphenous vein grafts (SVG), 3) it is possible to achieve complete myocardial revascularization with AC only, even in patients with impaired left ventricular function, and 4) AC can be used in elderly patients.