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Beating heart revascularization using only bilateral internal thoracic arteries for triple-vessel disease: early
Kiick Sung1, Young Tak Lee, Kay-Hyun Park
1Department of Thoracic and Cardiovascular Surgery of Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Completely arterial revascularization using bilateral internal thoracic arteries (ITAs) is feasible and safe for treating triple-vessel disease. Early outcomes are good, but competitive flow in less significant lesions requires further study for long-term efficacy.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Assessing the feasibility of completely arterial revascularization for triple-vessel disease using bilateral internal thoracic arteries (ITAs) on a beating heart.
- Investigating the safety and early outcomes of this surgical strategy.
Purpose of the Study:
- To establish the feasibility and safety of performing completely arterial revascularization using bilateral internal thoracic arteries (ITAs) in patients with triple-vessel disease.
- To evaluate early postoperative angiographic outcomes and identify risk factors for competitive flow patterns.
Main Methods:
- 113 patients with triple-vessel disease underwent beating heart revascularization using only bilateral ITAs.
- Early postoperative coronary angiography was performed in 59 sequential patients.
- Multivariate analysis identified risk factors for competitive flow.
Main Results:
- No operative deaths occurred; low rates of perioperative myocardial infarction and low cardiac output.
- High patency rates for both left (100%) and right (98.1%) ITAs.
- Competitive flow patterns observed in 10.5% of distal anastomoses, associated with less significant stenosis and lower intraoperative flow rates.
Conclusions:
- Beating heart revascularization with bilateral ITAs is a feasible and safe strategy with good early angiographic results.
- The prevalence of competitive flow in less significant lesions suggests this technique may need further validation for long-term patency and function.
Background:
Early postoperative coronary angiography was performed to establish the feasibility of treating patients with triple-vessel disease by performing completely arterial revascularization on the beating heart using only bilateral internal thoracic arteries (ITAs).
Methods:
Between March 2001 and February 2003, 113 patients with triple-vessel disease (age, 62.0 +/- 8.6 years) underwent beating heart revascularization using only the bilateral ITAs. Left ventricular ejection fractions ranged from 23% to 78% (mean, 51.3% +/- 15.1%). The incidence of diabetes mellitus was 46%. Early postoperative coronary artery angiographic follow-up was performed since May 2002 in the last 59 sequential patients.
Results:
There were no operative deaths. Perioperative myocardial infarction and postoperative low cardiac output occurred in only 1 patient each. The mean number of distal anastomoses was 3.9 +/- 0.7 per patient. The patency rates were 100% for the left ITA and 98.1% for the right. Competitive flow patterns were present in 25 distal anastomosis sites (10.5%). A multivariate analysis showed that the degree of stenosis (<75%), the extent of focal stenosis of the native coronary artery, and the intraoperative transit-time flow rate (<10 mL/min) were the statistically significant risk factors for competitive flow.
Conclusion:
This surgical strategy is feasible, is safe, and yields good early angiographic outcomes, even following beating heart revascularization. However, in less significant lesions competitive flow patterns were relatively prevalent, so this technique might be reserved until it is proven to provide good long-term patency and function.
