Complete myocardial revascularization using arterial grafts
L A Dallan1, S A de Oliveira, L A Lisboa
1Heart Institute, Hospital das Clinicas, Medical School, University of Sâo Paulo, Sâo Paulo, SP, Brazil. dcidallan@incor.usp.br
Insights
Complete arterial revascularization using only artery grafts is safe and effective for young patients. This approach minimizes the need for repeat surgeries, offering excellent short-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Complete arterial revascularization is crucial for young patients to prevent future reoperations.
- Assessing short-term outcomes of arterial graft-only revascularization in a young cohort.
Purpose of the Study:
- To evaluate the short-term results of complete arterial revascularization in young patients.
- To determine the safety and efficacy of using only arterial grafts for myocardial revascularization.
Main Methods:
- Retrospective analysis of 385 patients undergoing myocardial revascularization with artery grafts alone.
- Follow-up duration of 30 months.
- Utilized various arterial conduits including left and right internal thoracic arteries, radial artery, right gastroepiploic artery, and inferior epigastric artery.
Main Results:
- No intraoperative deaths occurred.
- Hospital mortality was 1.8% (7 deaths), with most fatalities in redo or combined procedures.
- Mean of 3.2 distal anastomoses per patient in those with multi-vessel disease.
Conclusions:
- Complete arterial reconstruction demonstrates acceptably low operative mortality.
- This strategy offers excellent short-term follow-up and is vital for young patients to reduce reoperation rates.
Background:
Complete arterial revascularization is important in younger patients to reduce the likelihood of future reoperation. We assessed the short-term outcome of a strategy to provide complete arterial revascularization in a cohort of young patients.
Methods:
Three hundred and eighty-five patients underwent myocardial revascularization using artery grafts alone and were followed up for 30 months. One hundred fourteen patients (29.6%) had single-vessel disease, 118 (30.6%) had two-vessel disease, and 153 (39.7%) had three or more obstructed coronary arteries. Eight of the patients had undergone previous surgical revascularization. The left internal thoracic artery (LITA) was routinely used for the left anterior descending branch (LAD). In 103 patients (28.1%), the in situ right internal thoracic artery (RITA) was used for revascularization of the right coronary artery (RCA) and its branches. The RITA was sometimes used as a free graft from the aorta or as an artificial "Y" from the LITA to the diagonal and marginal branches. Other arterial conduits included the radial artery (RA) in 215 patients (55.8%), the right gastroepiploic artery (RGEA) in 24 patients (6.3%), and the inferior epigastric artery (IEA) in four patients (1.1%).
Results:
In patients having lesions in three or more arteries, the mean number of distal anastomoses was 3.2 per patient. There were no intraoperative deaths. Hospital mortality was 1.8% (n = 7). Of the fatal cases, two were redos and two underwent combined procedures (one for left ventricular aneurysm and one for double valve replacement), while only three of the fatal cases underwent revascularization as a primary and isolated procedure.
Conclusions:
Complete arterial reconstruction carries an acceptably low operative mortality and excellent short-term follow-up. This strategy is particularly important for young patients to reduce the probability of future reoperation.
