Total arterial myocardial revascularization

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Saphenous vein graft failure is a primary reason for repeat coronary artery bypass surgery.
• Total arterial revascularization aims to improve long-term graft patency and patient outcomes.

Purpose of the Study:

• To assess the feasibility and efficacy of routine total arterial myocardial revascularization using pedicled bilateral internal mammary arteries with or without a radial artery.
• To establish this technique as a gold standard for myocardial revascularization.

Main Methods:

• A 7-year retrospective study of 1825 consecutive patients undergoing myocardial revascularization.
• Routine utilization of pedicled bilateral internal mammary arteries, with or without radial artery, for all arterial conduits.
• Analysis of total arterial revascularization rates, anastomoses performed, combined procedures, and early mortality.

Main Results:

• Total arterial revascularization was achieved in 99.5% of patients (1817/1825).
• A total of 5815 coronary anastomoses were performed using only arterial grafts.
• The early mortality rate was 2.6% in patients with a mean additive Euroscore of 7.4.

Conclusions:

• Routine use of bilateral mammary arteries and radial artery for myocardial revascularization is a feasible and efficient surgical strategy.
• This total arterial approach demonstrates excellent results and is highly recommended.
• The technique offers a superior alternative to traditional saphenous vein grafts, reducing the need for reintervention.