Complete arterial coronary revascularisation using radial artery conduit for double thoracic artery inlet flow:
John B Christensen1, Jens T Lund, Eli Kassis
1Department of Thoracic Surgery, Copenhagen County Hospital in Gentofte, Niels Andersens Vej 59, DK-2900 Hellerup, Denmark. jbchristensen@wanadoo.dk
Insights
The arterial sling operation offers complete arterial revascularisation for coronary artery disease, achieving excellent graft patency and improved blood flow. This innovative technique shows promise for enhancing outcomes in bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease Management
Background:
- Arterial grafts offer superior long-term patency in coronary artery bypass graft (CABG) surgery compared to venous grafts.
- Reaching the infero-lateral wall can be challenging with in situ internal thoracic arteries, necessitating alternative revascularisation strategies.
- The arterial sling operation is a novel surgical principle designed to complete total arterial revascularisation.
Purpose of the Study:
- To evaluate the initial outcomes of the arterial sling operation for complete arterial revascularisation in patients with three-vessel coronary artery disease.
- To assess the feasibility, safety, and early efficacy of using a free radial artery segment to augment internal thoracic artery grafts.
Main Methods:
- A technique involving end-to-end anastomosis of the right internal thoracic artery and a radial artery segment, followed by side-to-side anastomoses to revascularise target coronary branches.
- Utilisation of the left internal thoracic artery for the left anterior descending artery and an end-to-side anastomosis of the radial artery segment to the left internal thoracic artery.
- Coronary artery blood flow was measured using Doppler probes in 41 patients.
Main Results:
- 192 coronary anastomoses were performed in 46 patients, averaging 4.2 per patient.
- The arterial sling graft achieved a mean total blood flow of 104ml/min, significantly higher than single internal thoracic arteries (69-68ml/min).
- Postoperative angiography confirmed patent anastomoses to all coronary arteries, with no perioperative deaths or myocardial infarctions.
Conclusions:
- The arterial sling operation facilitates complete arterial revascularisation with acceptable crossclamp times and high early graft patency.
- This technique provides a 50% increase in blood flow and a two-fold increase in flow reserve to the heart compared to single arterial grafts.
- The arterial sling operation demonstrates promising potential for complete arterial coronary revascularisation, warranting further long-term investigation.
Background:
Coronary artery bypass graft surgery with arterial revascularisation of all diseased coronary vessels is considered highly efficient because arterial grafts have an excellent long-term patency compared with venous grafts. However, problems to reach the infero-lateral wall with the in situ internal thoracic arteries usually require alternative techniques. We present the first results of a new surgical principle using a free radial artery segment to complete the arterial coronary revascularisation and concomitantly connect the internal thoracic arteries.
Methods:
In patients referred for coronary bypass surgery and three-vessel disease an end-to-end anastomosis of the right internal thoracic artery and the radial artery segment preceded cardiopulmonary bypass, during which side-to-side anastomoses of the radial artery segment were used to revascularise stenotic branches of the right coronary and circumflex arteries. The left internal thoracic artery was used for revascularisation of stenotic branches of the left anterior descending artery, and finally an end-to-side anastomosis of the radial artery segment to the left internal thoracic artery was performed. Coronary artery blood flow was measured in 41 patients with Doppler flow probe.
Results:
One hundred and ninety-two coronary anastomoses (an average of 4.2 per patient) were performed in 46 patients. We measured a mean total blood flow in the arterial sling graft of 104ml/min (range 35-221ml/min), compared with 69 and 68ml/min of the single inlet right and left internal thoracic arteries, respectively (P<0.01). Flow capacities of 104 and 120ml/min of the right and left internal thoracic arteries were measured during clamp of both the aorta and the contralateral internal thoracic artery. The mean crossclamp duration was 77min (range 51-113min). Postoperative angiography demonstrated patent graft anastomoses to all coronary arteries. There were no perioperative deaths or myocardial infarctions. One patient had a minor postoperative stroke.
Discussion:
Complete arterial revascularisation can be achieved by the arterial sling operation with an acceptable crossclamp time and a high early rate of graft patency. The double arterial inlet provides a 50% higher blood flow to the beating heart and two-fold increase in the flow reserve compared with a single inlet. Although further research including long-term follow-up of this new principle is required, the present findings seem promising and suggest that the arterial sling operation has a potential role for complete arterial coronary revascularisation.
