Total arterial revascularisation in left ventricular dysfunction

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Vascular Surgery

Background:

• Patients with impaired left ventricular function often present complex surgical challenges.
• Coronary artery bypass grafting (CABG) is a standard treatment for ischemic heart disease.
• Total arterial revascularization (TAR) aims to improve long-term outcomes by using only arterial grafts.

Purpose of the Study:

• To evaluate the feasibility and safety of total arterial coronary revascularization (TAR) using two arterial conduits.
• To assess outcomes in patients with moderately or severely impaired left ventricular function undergoing TAR.
• To compare the utility of different arterial conduits in this patient population.

Main Methods:

• Prospective data collection from March 1995 to August 2002.
• Inclusion of 179 patients with multi-vessel disease and impaired left ventricular function undergoing TAR with two conduits.
• Analysis of perioperative outcomes including mortality, myocardial infarction, and stroke.

Main Results:

• Perioperative mortality was 2.2%, myocardial infarction 1.7%, and stroke 0.6%.
• A Y-graft configuration was used in 82% of patients, primarily utilizing the left internal mammary artery.
• The radial artery demonstrated sufficient length for revascularization, even in cases of left ventricular dilatation.

Conclusions:

• Total arterial coronary revascularization with two arterial conduits is a safe and feasible option for patients with ischemic left ventricular dysfunction.
• The radial artery is a valuable conduit, offering adequate length for complete revascularization, particularly in dilated ventricles.
• This surgical strategy can be safely implemented in a complex patient cohort, including those with prior sternotomies.