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Coronary-coronary bypass graft: an arterial conduit-sparing procedure
R Nottin1, J M Grinda, S Anidjar
1Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
Insights
Coronary-coronary bypass grafting, utilizing various arterial conduits like the internal thoracic artery, demonstrates excellent patency and functional outcomes in complex myocardial revascularization. This technique expands arterial graft use, preserving conduits for future procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
- Coronary-coronary bypass grafts (CCBGs) offer a solution for specific surgical challenges, including arterial conduit sparing and complex revascularization scenarios.
- The use of internal thoracic arteries (ITAs) is favored for their long-term patency in arterial grafting.
Purpose of the Study:
- To evaluate the outcomes of myocardial revascularization using coronary-coronary bypass grafts.
- To assess the patency rates, functional status, and long-term results of CCBGs.
- To determine the feasibility and benefits of expanded arterial graft utilization, particularly ITAs, in complex CABG procedures.
Main Methods:
- A retrospective analysis of 143 patients undergoing myocardial revascularization with CCBGs between May 1989 and December 1995.
- Detailed recording of graft types (arterial vs. venous), reasons for CCBG selection, and graft locations.
- Assessment of early postoperative patency via angiography and long-term functional status through exercise testing and clinical follow-up.
Main Results:
- A total of 463 distal anastomoses were performed, with 111 arterial grafts (75%) used, predominantly right and left internal thoracic arteries.
- Early postoperative angiography revealed a high patency rate of 98.6% for CCBGs.
- Excellent long-term functional outcomes were observed, with 97% of patients showing normal exercise test results at 2 months, decreasing slightly to 93% at 3 years.
Conclusions:
- Coronary-coronary bypass grafting is a safe and effective technique for complex myocardial revascularization.
- This approach facilitates the expanded use of arterial grafts, especially internal thoracic arteries, promoting conduit sparing.
- CCBGs provide excellent patency and functional results, contributing to successful long-term patient outcomes.
Abstract:
From May 1989 to December 1995, 143 patients underwent myocardial revascularization with one (138 patients) or two (five patients) coronary-coronary bypass grafts in addition to other bypass grafts, for a total of 463 distal anastomoses (mean 3.2 +/- 0.6 per patient). Coronary-coronary bypass grafts were chosen for the following reasons: arterial conduit-sparing procedure, inadequate length for in situ graft, calcified ascending aorta, and stenosed or occluded subclavian arteries. One hundred eleven arterial grafts (75%) were used: 85 right internal thoracic arteries, 18 left internal thoracic arteries, and eight radial arteries. Saphenous vein grafts were used in 37 cases (25%, mostly in our early experience). Coronary-coronary bypass grafts were performed on the right coronary artery in 134 cases (90.5%), on the circumflex artery in five cases (3.3%), on the left anterior descending coronary artery in four cases (2.7%), and between two different coronary arteries in five cases (3.3%). Three patients (2%) died of myocardial infarction. Early postoperative angiography showed a patency rate of 98.6% (72/73). During the mean follow-up of 34.6 +/- 20.8 months, two patients died and two underwent reoperation. Results of exercise testing were normal at 2 months in 97% of patients (90/92), at 1 year in 96% (81/84), and at 3 years in 93% (30/32). In conclusion, the coronary-coronary bypass graft provides good results with a variety of conduits and allows the expanded use of arterial grafts, particularly the internal thoracic artery. This can lead to a sparing of arterial conduit and allow complex myocardial revascularization with a liberal use of internal thoracic arteries.