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Total arterial myocardial revascularization

G Paolini1, M A Mariani, S Benussi

  • 1Institute for Cardiovascular and Respiratory Diseases, University of Milan, Scientific Institute H. San Raffaele, Italy.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 1, 1993
PubMed
Summary

Total arterial myocardial revascularization using internal thoracic artery (ITA) and inferior epigastric artery (IEA) grafts is safe and effective. This approach offers excellent long-term benefits for patients undergoing coronary artery surgery.

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Area of Science:

  • Cardiovascular Surgery
  • Vascular Grafting

Background:

  • Internal thoracic artery (ITA) demonstrates superior late graft patency compared to venous conduits.
  • Inferior epigastric artery (IEA) shows promise as an alternative conduit for coronary artery surgery with favorable early outcomes.

Purpose of the Study:

  • To evaluate the safety and efficacy of expanded use of arterial conduits for total arterial myocardial revascularization.
  • To assess the feasibility of performing multiple anastomoses using ITA and IEA grafts.

Main Methods:

  • Retrospective analysis of 615 coronary artery surgery patients from June 1988 to December 1991.
  • 138 patients (22.4%) underwent total arterial myocardial revascularization with 2 or more anastomoses using ITA and IEA grafts.
  • Detailed recording of perioperative morbidity and mortality.

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Main Results:

  • An average of 2.37 anastomoses per patient were performed, with a maximum of 6.
  • Low cardiac-related mortality (0.72%) and acceptable perioperative morbidity (3.6% for myocardial infarction and sternal dehiscence each).
  • No stroke, reoperation for bleeding, or rectus muscle necrosis were observed.

Conclusions:

  • Total arterial myocardial revascularization using bilateral ITA and single IEA grafts can achieve complete revascularization, even in complex three-vessel disease.
  • This strategy did not increase perioperative morbidity in the studied patient cohort.
  • Elective total arterial revascularization is recommended for younger patients (<65 years) likely to benefit from the long-term durability of arterial grafts.