Complete Arterial Coronary Artery Bypass Grafting Versus Conventional Revascularization - Early Results[*]

Background: Complete arterial coronary artery bypass grafting (CABG) offers the potential to improve long-term results. However, an increased perioperative risk has been controversially discussed. New operative techniques (skeletonization of the ITA/T-grafts/utilization of the radial artery (RA)) may decrease perioperative risk. We compared the outcome after conventional with that after complete arterial CABG. Material and Methods: Three consecutive groups of patients were analyzed. In group I (n = 50), CABG was performed using left ITA and vein grafts. The other two groups received complete arterial CABG with either both ITA's (group II; n = 52) or left ITA and RA (group III; n = 52). Results: A mean of 3.9 ± 0.8 (I) versus 4.2 ± 0.8 (II) and 3.9 ± 0.9 (III) anastomoses were performed per patient (ns). Mean operating time was significantly prolonged in group II (II: 252 ± 54; p < 0.0001; vs. I: 191 ± 36; III: 203 ± 33). Mean ischemic time was significantly prolonged in group II and III (II: 65 ± 20; p < 0.0001; III: 68 ± 16; p < 0.0001; vs. I: 51 ± 15). Mean bypass time (I: 83 ± 23; II: 95 ± 41; III: 91 ± 21), the rate of postoperative complications and in-hospital mortality (I: n = 0; II: n = 2; III: n =0; ns) showed no significant differences. Conclusions: Complete arterial CABG using modern surgical techniques is as safe as the conventional surgical approach using left ITA and vein graft.

Key words:

Cardiovascular disease - Coronary disease - Coronary surgery - Arteries - Revascularization

1 Presented at the 3rd Meeting of the Austrian, Switzerland and German Association of Thoracic and Cardiovascular Surgery, February 2000

References

• 1 Davis K B, Chaitman B, Ryan T, Bittner V, Kennedy J W. Comparison of 15-year survival for men an women after initial medical or surdical treatment for coronary artery disease: A CASS registry study.  J Am Coll Cardiol. 1995;  25 1000-1009
• 2 Peduzzi P, Kamina A, Detre K. Twenty-two-year-follow-up in the VA cooperative study of coronary artery bypass surgery for stable angina.  Am J Cardiol. 1998;  81 1393-1399
• 3 Powell J T, Gosling M. Molecular and cellular changes in vein grafts: influence of pulsatile stretch.  Curr Opin Card. 1998;  13 453-458
• 4 Loop F D, Cosgrove D M, Stewart R W, Goormastic M, Williams G W. et al . Influence of the internal mammary artery graft on 10-year survival and other cardiac events.  N Engl J Med. 1986;  314 1-6
• 5 Del Rizzo D F, Fremes S E, Christakis G T, Sever J, Goldman B S. The current status of myocardial revascularization.  J Card Surg. 1996;  11 18-29
• 6 Cameron A, Kemp H G, Green G E. Bypass surgery with the internal mammary artery graft: 15 year follow-up.  Circulation. 1986;  74 ( Suppl III) III-30-36
• 7 Lytle B W, Blackstone E H, Loop F D. et al . Two internal thoracic artery grafts are better than one.  J Thorac Cardiovasc Surg. 1999;  117 (5) 855-872
• 8 Bergsma T M, Grandjean J G, Voors A V, Boonstra P W, den Heyer P, Ebels T. Low recurrence of angina pectoris after coronary artery bypass surgery with bilateral internal thoracic and right gastroepiploic arteries.  Circulation. 1998;  97 2402-2405
• 9 Kochoukos N T, Wareing T H, Murphy S F, Pelate C, Marshall W G. Risk of bilateral internal mammary artery bypass grafting.  Ann Thorac Surg. 1990;  49 210-219
• 10 Jones E L, Lattouf O M, Weintraub W S. Catastrophic consequences of internal mammary artery hypoperfusion.  J Thorac Cardiovasc Surg. 1989;  98 902-907
• 11 He G W, Ryan W H, Acuff T E, Bowman R T, Douthit M B, Yang C Q. et al .Risk factors for operative mortality and sternal wound infection in bilateral internal mammary artery grafting. 1994 107: 196-202
• 12 Bical O, Braunberger E, Fischer M. et al . Bilateral skeletonized mamrnary artery grafting: experience with 560 consecutive patients.  Eur J Cardiothorac Surg. 1996;  10 971-976
• 13 Acar C, Jebara V A, Porthoghese M. et al . Revival of the radial artery for coronary artery bypass grafting.  Ann Thorac Surg. 1992;  54 652-660
• 14 Calafiore A M, Giammarco G D, Luciani N, Maddestra N, Nardo E D, Angelini R. Composite arterial conduits for a wider arterial myocardial revascularization.  Ann Thorac Surg. 1994;  58 185-190
• 15 Tector A J, Amundsen S, Schmahl T M, Kress D C, Peter M. Total revascularization with T-Grafts.  Ann Thorac Surg. 1994;  57 33-39
• 16 Wendler O, Tscholl D, Huang Q, Schäfers H J. Free flow capacity of skeletonized versus pedicled internal thoracic artery grafts in CABG.  Eur J Cardio Thorac Surg. 1999;  15 247-250
• 17 Calafiore A M, Vitolla G, Iaco A L. et al . Bilateral internal mammary artery grafting: Midterm results of pedicled versus skeletonized conduits.  Ann Thorac Surg. 1999;  67 1637-1642
• 18 Matsumoto M, Konishi Y, Miwa S, Minakata K. Effect of different methods of internal thoracic artery harvest on pulmonary function.  Ann Thorac Surg. 1997;  63 (3) 653-655
• 19 Rosenfeldt F L, He G W, Buxton B F, Angus J A. Pharmacology of coronary artery bypass grafts.  Ann thorac Surg. 1999;  67 878-888
• 20 Wendler O, Hennen B, Markwirth T, Tscholl D, Huang Q, Schäfers H J. T-grafts with bilateral ITA versus left ITA and radial artery: Flow dynamics in the ITA mainstem.  J Thorac Cardiovasc Surg. 1999;  118 841-848

1 Presented at the 3rd Meeting of the Austrian, Switzerland and German Association of Thoracic and Cardiovascular Surgery, February 2000