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The road to complete arterial grafting for coronary artery disease
1University of Melbourne, Cardiac Surgery Department, Austin & Repatriation Medical Centre, Heidelberg, Victoria, Australia. bux@austin.unimelb.edu.au
Insights
Bilateral internal thoracic artery grafting significantly improves 10-year survival compared to single grafting. Total arterial grafting using radial and internal thoracic arteries shows promising early results for coronary artery disease patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- The study reviews a shift in surgical strategy from single to bilateral internal thoracic artery (ITA) grafting starting in 1984.
- Further evolution towards total arterial grafting using radial artery (RA) and ITA combinations was implemented in 1995.
Purpose of the Study:
- To evaluate the long-term benefits of bilateral ITA grafting compared to single ITA grafting.
- To assess the early outcomes of total arterial revascularization strategies incorporating radial arteries for coronary artery disease (CAD).
Main Methods:
- Retrospective analysis of patient survival data comparing single versus bilateral ITA grafting over a 12-year period.
- Prospective evaluation of early postoperative complications, cardiac enzyme levels (creatinine kinase MB), and myocardial infarction rates in patients undergoing total arterial grafting.
Main Results:
- Bilateral ITA grafting demonstrated a significantly higher 10-year survival rate (86.9%) compared to single ITA grafting (74.2%), with a mortality rate ratio of 1.4 (P=0.009).
- Patients receiving at least one radial artery graft showed lower postoperative creatinine kinase MB levels and myocardial infarction rates compared to those without RA grafts.
- No increase in early complications was observed in the initial 2 years following the adoption of total arterial grafting.
Conclusions:
- The addition of a second internal thoracic artery graft provides a significant survival benefit in coronary artery bypass grafting.
- Total arterial revascularization using combinations of internal thoracic and radial arteries is a safe and effective strategy for coronary artery disease, with favorable early outcomes.
Abstract:
In 1984, our department moved to the use of single, and subsequently, bilateral internal thoracic artery grafting which, when reviewed after 12 years, suggest the addition of a second internal thoracic artery is beneficial. The 10-year survival using all-cause mortality was 86.9% for bilateral internal thoracic artery grafting compared with 74.2% for the use of a single internal thoracic artery graft. The mortality rate ratio for single versus bilateral internal thoracic artery grafts was 1.4 (P=0.009). In 1995, we entered an era of total arterial grafting using combinations of radial and internal thoracic arteries. There have been no additional early complications in the first 2 years, furthermore the early results show that the postoperative creatinine kinase MB isoenzyme and the myocardial infarction rates were lower in patients receiving at least one radial artery graft compared with those not receiving a radial artery graft. Continued use of internal thoracic and radial arteries to achieve complete arterial revascularisation for patients with coronary artery disease appears justified.