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Results of coronary artery bypass grafting using multiple arterial conduits
C A Dietl1, N P Madigan, F J Menapace
1Department of Cardiovascular Surgery, Geisinger Medical Center, Danville, Pennsylvania 17822-1343.
Insights
Multiple arterial conduits in coronary artery bypass grafting (CABG) showed promising results. Patients receiving only arterial grafts (group A) experienced better outcomes than those with combined arterial and vein grafts (group B).
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- The use of autologous arterial conduits has gained attention for improved long-term patency compared to vein grafts.
- Optimizing graft selection is crucial for enhancing CABG outcomes.
Purpose of the Study:
- To compare the early and late outcomes of coronary artery bypass grafting (CABG) using exclusively multiple arterial conduits versus a combination of arterial and saphenous vein grafts.
- To evaluate the efficacy and safety of all-arterial grafts in a diverse patient population.
Main Methods:
- A retrospective study of 128 patients undergoing CABG between January 1991 and June 1993.
- Patients were divided into two groups: Group A (exclusively arterial grafts) and Group B (arterial and saphenous vein grafts).
- Data collected included patient demographics, graft types, perioperative complications, and clinical follow-up including symptom status and myocardial perfusion imaging.
Main Results:
- Early mortality was 1.4% in Group A and 8.5% in Group B. Perioperative myocardial infarction occurred in 1.4% of Group A and 5.1% of Group B.
- At a mean follow-up of 12.9 months, no late deaths or reoperations were reported in either group.
- All patients in Group A remained symptom-free, while Group B had 2 cases of recurrent angina and 1 late myocardial infarction in a vein graft distribution. Myocardial SPECT revealed perfusion defects in 1/49 patients in Group A vs. 3/49 in Group B.
Conclusions:
- Exclusive use of multiple arterial conduits in CABG appears to be associated with superior clinical outcomes and reduced adverse events compared to combined arterial and vein grafting.
- All-arterial grafting strategies may offer a significant advantage in preventing graft-related complications and improving long-term patient well-being.
- Further investigation into optimizing all-arterial grafting techniques is warranted to maximize benefits in coronary revascularization.
Abstract:
Between January 1991 and June 1993, a total of 128 patients underwent coronary artery bypass grafting employing multiple autologous arterial conduits, including 157 internal mammary arteries, 69 inferior epigastric arteries, 44 gastroepiploic arteries, and 72 radial artery grafts. Their mean age was 61.4 years (range 29 to 82 years). The patients were divided into 2 groups: group A, consisted of 69 patients (mean age 60.3 years), in whom multiple arterial conduits were used exclusively (no vein grafts); group B, included 59 patients (mean age 62.7 years) in whom, in addition to multiple arterial conduits, 89 saphenous vein grafts were used concomitantly. The mean number of grafts was 3.1 and 3.7, for groups A and B, respectively. The preoperative left ventricular function, and the prevalence of unstable angina, a recent myocardial infarction, and diabetes, were not significantly different between both groups. Our series included 11 "redo" operations (8 in group A, and 3 in group B). There were 6 early deaths (4.7% mortality) (1 in group A, and 5 in group B), and 4 perioperative myocardial infarctions (1 in group A, 3 in group B). During a mean follow-up of 12.9 months (range 1 to 28 months) there were no late deaths or reoperations in any group. All patients in group A are free of symptoms. In group B, 2 patients have recurrent angina, and 1 had a late myocardial infarction, in the distribution of a vein graft. A myocardial SPECT scan with exercise revealed new perfusion defects in 4 of 49 patients (1 in group A, 3 in group B), studied 1 year after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)