Total arterial revascularisation in patients with end-stage heart failure

Objectives: Flow in arterial grafts, in patients with terminal coronary arthery disease TCAD, is adapted according to myocardial need for oxygen. Aim of this study was to determine survival and outcome in patients with TCAD, after total arterial revascularisation (TAR) and left ventricular (LV) reconstruction.

Methods: From 08/2001–09/2005, 124pts with TCAD (NYHA class IV) underwent (TAR) and LV reconstruction. After preparation of left internal mammary (LIMA) as a main graft, and patient full heparinisation, radial artery (RA) was connected on LIMA's middle parts as a "T" graft. Than we started with extracorporeal circulation, LV aneurysm is resected, LIMA is anastomozed with LAD, and RA with other arterias in jump fashion or as a free graft. We compared preoperative and postoperative echocardiographic and haemodynamic data.

Results: Left internal mammary artery (IMA) was used at 124 (100%), right IMA in 23 (18.6%), left radial artery as T graft to LIMA in 83 (67%) pts, as T-T anastomosis to RIMA in 1patient and as free graft in29 (23.5%). Postoperative echocardiographia and hemodynamic improvemenmt was notified in all patients: EDV/ESV decreased from 386±3.5/329±19.5 on 190±18.5/115±14.9, EF increased from 20% on 35%. After one year EDV/ASV was additionally decreased on 176±15.6/98±18.5, and EF was increased on 35–37%. Early mortality rate was 7.3% (9 pts). Late mortality was 2.6% (3 pts). Control coronarographia performed on pts with postoperative angina symptoms, showed better arterial graft flow and increased diameter of RA, compared with preoperatively.

Conclusion: TAR in combination with LV surgical reconstruction in patients with TCAD ensuring better myocardial flow according on myocardial demand, results with better clinical outcome. Good early angiographic results been achieved by using radial artery in coronary surgery.