Complete revascularization with three or more arterial conduits

A complete revascularization with three or more arterial conduits was achieved, giving the patient, if possible, three blood sources from the in situ arterial grafts (skeletonized bilateral internal thoracic arteries [ITAs] and right gastroepiploic artery). If one of these conduits was not available, a radial artery was used, the proximal anastomosis being constructed on an ITA. The inferior epigastric artery was used if a sequential anastomosis was not advisable or to lengthen another arterial graft. With this strategy, 247 patients underwent surgery from October 1991 through April 1995; 774 arterial conduits were used: 244 left ITAs, 187 right ITAs, 159 right gastroepiploic arteries, 114 radial arteries, and 70 inferior epigastric arteries. The in-hospital and late mortality rates were 1.2% (3 patients) and 1.6% (4 patients), respectively. Of the 240 patients alive, 235 (97.9%) are asymptomatic. We compared the 42-month survival and event-free survival curves of these patients with those of an historical cohort of patients who underwent surgery with mixed (1 left ITA and saphenous vein grafts) revascularization. Whereas the survival rate was similar (97.82% +/- 1.11% vs 99.35% +/- 0.65, P = .174), the event-free survival rate was significantly better in the total arterial group (93.72% +/- 2.1 % vs 85.62% +/- 2.84%, P = .021). We conclude that complete revascularization with three or more arterial conduits is technically feasible with a low mortality rate; the mid-term results allow us to continue this strategy of myocardial revascularization.