Total arterial revascularisation as a primary strategy for coronary artery bypass grafting
1Department of Cardiac Surgery, John Radcliffe Hospital, Oxford, UK.
Insights
Total arterial revascularisation using bilateral internal thoracic and radial arteries is feasible for first-time coronary artery bypass grafting (CABG). This approach offers comparable outcomes to conventional CABG, making it a viable primary strategy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- Bilateral internal thoracic arteries improve survival post-coronary artery bypass grafting (CABG).
- Arterial conduits are underutilized in the UK for CABG despite evidence.
- Feasibility of total arterial revascularisation as a primary CABG strategy requires assessment.
Purpose of the Study:
- To assess the feasibility of total arterial revascularisation as a primary strategy in first-time CABG patients.
- To compare outcomes between total arterial revascularisation and conventional CABG.
Main Methods:
- A study of 245 first-time CABG patients from June 1999 to October 2000.
- Group 1: 165 patients with total arterial revascularisation (bilateral internal thoracic and radial arteries).
- Group 2: 80 patients with conventional CABG (one internal thoracic artery and veins).
- Primary outcomes: 30-day mortality and early morbidity (bleeding, stroke, renal failure, sternal dehiscence).
Main Results:
- Total arterial revascularisation use increased from 44% to over 75% during the study.
- Patients in the total arterial group were younger and had lower risk scores.
- 30-day mortality was low (1.3% overall), with similar rates in both groups (0.6% vs 2.5%).
- Postoperative complications and hospital stay were comparable between groups.
Conclusions:
- Total arterial revascularisation is a feasible primary strategy for most CABG patients.
- This approach can be adopted without increasing mortality or morbidity.
- Evidence supports wider adoption of total arterial revascularisation in CABG procedures.
Background:
Bilateral internal thoracic arteries confer improved survival benefit after coronary artery bypass grafting (CABG). Despite increasing evidence, the use of arterial conduits has not been accepted as a primary practice in most of the centres in the UK for various reasons. A series of patients has been analysed to assess the feasibility of total arterial revascularisation as a primary strategy in patients requiring first time CABG.
Methods:
Altogether 245 patients undergoing first time CABG by one surgeon, from June 1999 to October 2000, were studied. Group 1 consisted of 165 patients undergoing total arterial revascularisation (using bilateral internal thoracic and radial arteries) and group 2 consisted of 80 patients undergoing conventional CABG (using one internal thoracic artery and supplemental veins). Thirty day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures.
Results:
Patients in group 1 were younger (mean (SD) 60 (10) v 65 (9) years; p<0.001), had lower Parsonnet scores (mean (SD) 5 (5) v 11 (7); p<0.001), and better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularisation rose from 44% in the first three months to over 75% in the three latter three month periods. Overall 30 day mortality was 1.3%, one patient (0.6%) in group 1 and two patients (2.5%) in group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups.
Conclusion:
Total arterial revascularisation can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.
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