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Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries
E E Weinschelbaum1, E D Gabe, A Macchia
1Department of Cardiovascular Surgery, Favaloro Foundation, Buenos Aires, Argentina.
Insights
Total arterial revascularization is feasible using the radial artery for bypass grafting. This approach demonstrated excellent graft patency and minimal complications, offering a promising alternative for coronary artery bypass surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting
Background:
- Coronary artery disease necessitates effective revascularization strategies.
- Total arterial revascularization aims to improve long-term outcomes.
- The radial artery is a potential conduit for coronary artery bypass grafting.
Purpose of the Study:
- To assess the feasibility of total arterial revascularization using the radial artery.
- To evaluate the efficacy and safety of radial artery grafts in coronary artery bypass surgery.
- To determine graft patency and patient outcomes with this technique.
Main Methods:
- Prospective study involving 164 patients undergoing coronary artery bypass grafting.
- Radial artery used as a free Y or T graft from the left internal thoracic artery.
- Grafts supplied the circumflex, diagonal, and right coronary arteries; left internal thoracic artery supplied the left anterior descending artery.
Main Results:
- Total arterial revascularization achieved in 83.5% of patients.
- Excellent angiographic patency of all arterial conduits observed.
- Low rates of postoperative morbidity (1.8% myocardial infarction) and mortality (1.8%).
Conclusions:
- The radial artery is a viable conduit for total arterial revascularization in coronary artery bypass surgery.
- This technique offers excellent patency rates and minimal morbidity.
- Further long-term studies are warranted to confirm definitive outcomes.
Objective:
We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery.
Methods:
In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 +/- 1 [standard deviation] per patient), 296 (1.8 +/- 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 +/- 6.1) months.
Results:
Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms.
Conclusions:
The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.