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Arterial end-to-side grafting in coronary artery bypass grafting: the Tector procedure
M de Mulder1, C J M Broers, E K Jansen
1Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands.
Insights
All-arterial coronary artery bypass grafting using both internal mammary arteries is a safe and feasible option for patients with three-vessel coronary disease, showing low mortality and rare late adverse events.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is the standard treatment for three-vessel coronary disease.
- Internal mammary artery grafts offer superior long-term outcomes compared to venous grafts.
- Assessing the safety and feasibility of Tector's all-arterial CABG technique is crucial.
Purpose of the Study:
- To evaluate the safety and feasibility of all-arterial coronary artery bypass graft surgery using the Tector technique.
- To assess short-term and long-term outcomes of this surgical approach.
Main Methods:
- A study of 133 patients undergoing non-emergency surgical revascularization between June 2001 and February 2007.
- Primary endpoints included 30-day mortality or re-infarction.
- Secondary endpoints assessed emergency re-operations, angioplasty, and mediastinitis, with a mean follow-up of 33 months.
Main Results:
- Successful revascularization in all 133 patients, predominantly off-pump (98%).
- Full arterial grafting achieved in 93% using both internal mammary arteries.
- Low 30-day mortality (1.5%), with rare instances of re-thoracotomy, myocardial infarction, and mediastinitis.
Conclusions:
- All-arterial CABG using both internal mammary arteries via the Tector technique is safe and feasible.
- The procedure does not lead to an excess of deep sternal wound infections.
- Late adverse cardiac events are infrequent and often manageable with percutaneous coronary intervention for distal graft dysfunction.
Abstract:
Background. The current treatment of choice in patients with three-vessel coronary disease is coronary artery bypass grafting. The use of the left internal mammary artery in bypass grafting has shown superior long-term outcomes compared with venous grafting. In our study we assess the safety and feasibility of all-arterial coronary artery bypass graft surgery using the procedure as described by Tector et al. in 2001.Methods. Between June 2001 and February 2007, we studied 133 patients eligible for non-emergency surgical revascularisation. Primary endpoints were death or re-infarction within a 30-day period. Secondary endpoints were the need for emergency coronary surgery, angioplasty and mediastinitis. Long-term follow-up had a mean duration of 33 months postoperatively.Results. All 133 patients were successfully revascularised, 98% with the off-pump technique. In 93% of the patients (n=124) full arterial grafting was achieved using both internal mammary arteries. Thirty-day mortality was 1.5% (n=2), ten re-thoracotomies were performed, one myocardial infarction and one case of mediastinitis were reported. In the next four years six additional patients died. Most of these deaths were due to non-cardiovascular causes. Two patients required angioplasty because of distal bypass graft failure and one for new native coronary artery disease. Conclusion. All-arterial bypass grafting using both internal mammary arteries with the technique as described by Tector is safe and feasible without excess deep sternal wound infections. Late major adverse cardiac events are rare and due to distal graft dysfunction, which can be treated by percutaneous coronary intervention. (Neth Heart J 2010;18:7-11.).
