RESULTS OF CORONARY-ARTERY BYPASS-GRAFTING USING MULTIPLE ARTERIAL CONDUITS

Between January 1991 and June 1993, a total of 128 patients underwent coronary artery bypass grafting employing multiple autologous arterial conduits, including 157 internal mammary arteries, 69 inferior epigas tric arteries, 44 gastroepiploic arteries, and 72 radial artery grafts . Their mean age was 61.4 years (range 29 to 82 years). The patients w ere divided into 2 groups: group A, consisted of 63 patients (mean age 60.3 years), in whom multiple arterial conduits were used exclusively (no vein grafts); group, included 53 patients (mean age 62.7 years) i n whom, in addition to multiple arterial conduits, 89 saphenous vein g rafts were used concomitantly. The mean number of grafts was 3.1 and 3 .7, for groups A and B, respectively. The preoperative leftventricular function, and the prevalence of unstable angina, a recent myocardial infarction, and diabetes, were not significantly different between bot h groups. Our series included 11 ''redo'' operations (8 in group A, an d; 3 in group B). There were 6 early deaths (4.7% mortality) (1 in gro up A, and 5 in group B), and 4 perioperative myocardial infarctions (1 in group A, 3 in group B). During a mean follow-up of 12.3 months (ra nge 1 to 28 months) there were no late deaths or reoperations in any g roup. All patients in group A are free of symptoms. In group B, 2 pati ents have recurrent angina, and 1 had a late myocardial infarction, in the distribution of a vein graft. A myocardial SPECT scan with exerci se revealed new perfusion defects in 4 of 49 patients (1 in group A, 3 in group B), studied 1 year after surgery. In summary, multiple arter ial conduits can be used safely for coronary bypass surgery, and ''red o'' operations, with no increased surgical risk, and excellent results after 2 years. A long-term follow-up will be necessary to determine i f a complete myocardial revascularization without vein grafts will eff ectively decrease the incidence of recurrent symptoms, late events, or the heed for reoperation.