Coronary revascularization with the left internal thoracic artery and radial artery: comparison of short-term
Roberto Rocha-E-Silva1, Antônio de Pádua Mansur, José Fabri Junior
1Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Insights
Emergency coronary artery bypass grafting using left internal thoracic artery and radial artery grafts shows similar short-term outcomes to elective procedures. This approach can achieve complete revascularization in urgent cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Arterial Conduits
Background:
- Left internal thoracic artery (LITA) grafting is standard in coronary artery bypass grafting (CABG).
- Radial artery (RA) is increasingly used as an alternative arterial conduit.
- The safety and efficacy of RA grafting in emergency CABG are not well-established.
Purpose of the Study:
- To compare the short-term clinical outcomes of elective versus emergency CABG.
- To evaluate the use of LITA and RA grafts in both patient groups.
- To determine if RA grafting is suitable for emergency CABG patients.
Main Methods:
- Retrospective study of 47 patients undergoing CABG between 1996-2003.
- Patients received LITA and/or RA grafts for severe coronary stenosis (>70%).
- Groups: elective (23) vs. emergency (24), with emergency defined by unstable angina or critical stenosis.
Main Results:
- No significant difference in the number of LITA or RA grafts used between groups.
- Zero 30-day mortality and no postoperative cardiogenic shock in either group.
- Emergency group had a higher incidence of postoperative acute myocardial infarction (20.8% vs. 4.4%), though not statistically significant (P=.18).
Conclusions:
- Complete revascularization using LITA and RA grafts is feasible in emergency CABG.
- Outcomes in emergency CABG patients are comparable to elective CABG patients in the short term.
- Arterial grafting with LITA and RA can be safely applied in emergency settings.
Background:
Left internal thoracic artery-to left anterior descending artery grafting has become a fundamental part of coronary artery bypass grafting. This grafting has led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting can be used in the emergency patient is not known. This study compares the short-term clinical evolution between elective vs emergency coronary artery bypass grafting surgery with left internal thoracic artery and radial artery.
Methods:
A retrospective study of 47 patients who underwent elective or emergency coronary artery bypass grafting from 1996 to 2003. All patients had coronary stenosis>70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels.
Results:
The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P=.17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P=.48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P=.18). Intensive care unit and postoperative stay were similar in both groups.
Conclusion:
Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.
More Related Videos
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction