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Myocardial revascularization with bilateral internal thoracic artery in patients with left main disease or left
S Benussi1, M A Mariani, F Donatelli
1Istituto Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi, IRCCS H San Raffaele, Milano.
Insights
The internal thoracic artery (ITA) shows safe perioperative performance in patients with left main disease (LMD) and left ventricular dysfunction (LVD). Extensive use of ITA grafts is feasible and not associated with increased risks in these complex patient groups.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Long-term patency of the internal thoracic artery (ITA) is established.
- Concerns exist regarding the perioperative performance of ITA grafts, particularly in complex patient populations.
Purpose of the Study:
- To evaluate the perioperative safety and outcomes of using internal thoracic artery (ITA) grafts in patients with left main disease (LMD) and left ventricular dysfunction (LVD).
Main Methods:
- Retrospective analysis of 122 consecutive coronary artery bypass grafting patients from March 1988 to September 1992.
- Patients were stratified based on left main disease (LMD) or left ventricular dysfunction (LVD) and the number of ITA grafts used (single vs. bilateral).
- Perioperative complications including myocardial necrosis, need for intra-aortic balloon pump (IABP), and mortality were assessed.
Main Results:
- In LMD patients, perioperative myocardial necrosis rates were 6.9% (LMD I) vs. 8.8% (LMD II), and IABP use was 6.9% vs. 5.9%, with no deaths in either group.
- In LVD patients, mortality was 2.2% (LVD I) vs. 6.7% (LVD II), myocardial necrosis was 4.5% vs. 6.7%, and IABP use was 9.1% vs. 13.3%.
- The use of bilateral ITA grafts in patients with LMD and LVD was not associated with increased perioperative risk.
Conclusions:
- Left main disease (LMD) and left ventricular dysfunction (LVD) should not be considered contraindications for the extensive use of arterial conduits, specifically ITA grafts.
- Internal thoracic artery (ITA) grafting demonstrates acceptable perioperative performance in high-risk cardiac surgery patients.
- The study supports the broader application of arterial grafts in complex coronary artery bypass grafting scenarios.
Abstract:
Although long-term patency of the internal thoracic artery (ITA) is well stated, there is still some concern about its perioperative performance. We considered 122 consecutive patients, 63 with left main disease (LMD; mean age 60 years) and 59 with left ventricular dysfunction (LVD; mean age 59 years) who underwent coronary artery bypass grafting in our Institute from March 1988 to September 1992. Patients with LMD were divided into 2 groups: LMD I: 29 patients receiving only ITA grafts on the left coronary system and LMD II: 34 patients having a single ITA graft on the left coronary system. Patients with LVD were divided into: LVD I: 44 patients operated with bilateral ITA and LVD II: 15 patients receiving a single ITA graft. Perioperative complications in LMD I and LMD II patients were respectively: myocardial necrosis in 2 (6.9%) versus 3 (8.8%), use of intra-aortic balloon pump (IABP) in 2 (6.9%) versus 2 (5.9%); no death occurred in both groups. Perioperative results in groups LVD I and LVD II were: death in 1 patient (2.2%) versus 1 (6.7%), myocardial necrosis in 2 (4.5%) versus 1 (6.7%) and IABP in 4 (9.1%) versus 2 (13.3%). In our experience the use of bilateral ITA grafts in patients with LMD and LVD was not related to an incremental risk. We conclude that LMD and LVD should not be considered as contraindications to the extensive use of arterial conduits.