DEVELOPMENTS IN SURGICAL TECHNIQUES FOR CORONARY REVASCULARIZATION

Citation
O. Alfieri et R. Lorusso, DEVELOPMENTS IN SURGICAL TECHNIQUES FOR CORONARY REVASCULARIZATION, Current opinion in cardiology, 10(6), 1995, pp. 556-561
Citations number
NO
Categorie Soggetti
Cardiac & Cardiovascular System
ISSN journal
02684705
Volume
10
Issue
6
Year of publication
1995
Pages
556 - 561
Database
ISI
SICI code
0268-4705(1995)10:6<556:DISTFC>2.0.ZU;2-I
Abstract
The wider application of arterial conduits represents a current trend in myocardial revascularization. More complex and demanding surgical t echniques are being developed as alternatives to traditional grafting procedures, in order to permit total arterial revascularization in pat ients with diffuse coronary artery disease. The rationale behind this strategy is the expected higher long-term patency rate of arterial con duits as compared with vein grafts. Avoidance of proximal anastomoses is another argument in favor of coronary revascularization with arteri al grafts, particularly in patients with atherosclerotic changes in th e ascending aorta. Although the reported operative results are good, t otal arterial revascularization in multivessel disease is a complex pr ocedure, and serious perioperative complications are possible. In plan ning the revascularization strategy, therefore, the surgeon should tak e into account age, clinical condition, coexisting medical problems, c oronary anatomy, and left ventricular function. The method of myocardi al revascularization is an important aspect of the surgical procedure and plays a major role in the outcome of the operation in the presence of severe left ventricular dysfunction or when the operation requires prolonged ischemic times. To avoid the inevitable damaging effects of cardiopulmonary bypass and aortic cross-clamping, myocardial revascul arization is carried out without extracorporeal circulation. This tech nique should be part of the armamentarium of the cardiac surgeon and s hould occasionally be considered in patients who have serious coexisti ng medical problems or severe left ventricular dysfunction.