Complete arterial revascularization in multivessel coronary artery disease with 2 conduits (skeletonized grafts and T
O Wendler1, B Hennen, S Demertzis
1Klinik für Thorax- und Herz-Gefässchirurgie, Universitätskliniken des Saarlandes, Kirrberger Strasse 1, D-66421 Homburg/Saar, Germany. chowen@med-rz.uni-sb.de
Insights
Complete arterial coronary artery bypass grafting (CABG) using only two grafts is feasible for multivessel disease. This approach offers good perioperative outcomes and excellent graft patency, making it a viable routine option.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Complete arterial coronary artery bypass grafting (CABG) aims for improved long-term outcomes in coronary artery disease (CAD).
- Traditional multi-arterial graft harvesting can lead to longer surgeries and increased patient trauma.
- Novel techniques like skeletonized grafts and T-grafting enable CABG with fewer grafts.
Purpose of the Study:
- To evaluate the feasibility and outcomes of routine complete arterial CABG using only two grafts in patients with multivessel CAD.
- To assess the perioperative results and graft patency rates of this streamlined arterial grafting approach.
Main Methods:
- A retrospective analysis of 490 patients undergoing complete arterial CABG between March 1996 and September 1999.
- Utilized either bilateral internal thoracic arteries (ITAs) or left ITA combined with the radial artery as grafts.
- Employed T-grafting in most cases, with detailed recording of operative times and perioperative complications.
Main Results:
- The study included 490 patients with a high prevalence of triple-vessel disease (88%) and diabetes (32%).
- Mean operating time was 198 minutes, with low rates of perioperative myocardial infarction (1.2%), sternal complications (1.0%), and in-hospital mortality (2.2%).
- Postoperative angiography demonstrated excellent graft patency: left ITA (98.3%), right ITA (96.5%), and radial artery (96.6%).
Conclusions:
- Complete arterial revascularization for multivessel CAD is achievable using just two arterial grafts.
- This simplified approach yields favorable perioperative results and high long-term graft patency.
- The described techniques allow for the routine implementation of complete arterial CABG.
Background:
Complete arterial CABG is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma. By use of new operative techniques (skeletonized grafts and the T-graft approach), CABG in multivessel CAD is now possible with only 2 grafts. We present our experience in the use of these techniques on a routine basis.
Methods And Results:
Between March 1996 and September 1999, 490 patients (aged 61+/-9 years, 20% female) underwent complete arterial CABG. Left ventricular ejection fraction ranged from 15% to 85% (mean 59+/-15%). Triple-vessel disease was present in 88% of the patients. The incidence of diabetes mellitus was 32% (14% insulin dependent). Either both internal thoracic arteries (ITAs) (23%) or the left ITA and radial artery (77%) were used as conduits. In 85% of the patients, a T graft was created. Mean operating time was 198+/-46 minutes; bypass time, 82+/-25 minutes; and ischemic time, 58+/-22 minutes. Two to 7 (mean 4.1+/-0.9) anastomoses were performed per patient. Perioperative intra-aortic balloon pump was necessary in 12 patients (2.4%). The rate of perioperative myocardial infarction was 1.2%. Sternal complications occurred in 1. 0%, and in-hospital mortality was 2.2%. Postoperative coronary angiography in 172 patients (35%) documented excellent patency rates (left ITA 98.3%, right ITA 96.5%, and radial artery 96.6%).
Conclusions:
Complete arterial revascularization in multivessel CAD is possible with the use of only 2 grafts with good perioperative results. This approach allows for complete arterial CABG on a routine basis.
