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[Coronary revascularization with arterial graft alone]
1Department of Cardiovascular Surgery, Koseiren Hiroshima General Hospital, Japan.
Insights
Arterial grafts, including the left internal thoracic artery (LITA) and right gastroepiploic artery (RGEA), were used for coronary revascularization in 56 patients. This technique demonstrated a high graft patency rate of 94.3% with favorable outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Coronary artery disease necessitates revascularization procedures.
- Traditional methods often involve venous grafts, which have limitations.
- Arterial grafts offer potential advantages in long-term patency and durability.
Purpose:
- To evaluate the efficacy and safety of using exclusively arterial grafts for coronary revascularization.
- To assess the graft patency rates and early outcomes in patients undergoing arterial grafting.
- To determine the feasibility of utilizing internal thoracic artery (ITA) and gastroepiploic artery grafts in diverse coronary artery disease scenarios.
Summary:
- A study involving 56 patients (December 1989-July 1991) utilized only arterial grafts (LITA, RITA, RGEA) for coronary revascularization.
- An average of 2.6 bypasses were performed per patient, with 143 grafts in total.
- Postoperative angiography revealed a high graft patency rate of 94.3% (115 out of 122 grafts).
- Two operative deaths occurred, one in a patient with acute myocardial infarction.
Impact:
- The study highlights the successful application of arterial grafting, including in emergency situations.
- This technique allows for in situ anastomoses to all coronary arteries.
- The findings suggest that arterial grafting is a valuable technique with potential for favorable long-term results in coronary revascularization.
Abstract:
In the period from December 1989 until July 1991, coronary revascularization were performed on 56 patients using arterial grafts and no venous grafts. The ages of the patients ranged from 43 to 85 years (average; 66.8 years), and there were 33 males and 23 females. Twenty-four patients had angina pectoris, 23 had old myocardial infarction and 9 had acute infarction. There were 3 patients with single-vessel coronary disease, 19 with double-vessel, 31 with triple-vessel and 9 with left main coronary disease. The bypass grafts used were 58 left internal thoracic artery (LITA) grafts, 29 right internal thoracic artery (RITA) grafts, and 56 right gastroepiploic artery (RGEA) grafts. Thus, 143 grafts were used and an average of 2.6 bypasses were created per patient. There were two operative deaths. One of these patients had acute myocardial infarct. Investigation of postoperative graft patency was performed in the 122 grafts that could be examined angiographically after surgery. Only 7 were obstructed, yielding a patency rate of 94.3%. By using both the ITA and RGEA, in situ anastomoses with all the coronary arteries could be performed. Also in emergency surgery arterial grafting was possible. This operative form is considered to be a useful technique and may be expected to produce favorable long-term results.