MIDTERM FOLLOW-UP OF 183 ARTERIAL MYOCARDIAL REVASCULARIZATION PROCEDURES

Objective: To evaluate the mid-term results of complete arterial myoca rdial revascularization performed with arterial conduits. Methods: Fro m July 1987 to December 1994, 183 patients underwent a myocardial reva scularization procedure with the use of at least two arterial grafts ( IMAs, rGEA, IEA) at our institute. Their mean age was 56 +/- 8.7 years , the redo-operation rate was 16.9% (31/183), two-vessel disease was p resent in 61 patients (33.3%), three-vessel disease in 122 (66.7%). Re sults: The LIMA was used in 179 patients (97.8%), the RIMA in 116 (63. 4%), the rGEA in 66 (36.1%) and the IEA in 41 (22.4%). In-hospital mor tality was 1.1% (2/183), while the perioperative myocardial infarction (MI) rate was 2.2% (4/183). The angiographic restudy, performed on 87 (47.5%) patients during the early postoperative period (median 38 day s) showed the following grafts patency rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05 (33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35 months. Kaplan-Meier surviv al was 96 +/- 2% at 3 and 5 years, freedom from angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-Meier freedom from ca rdiac events was 90 +/- 3% at 3 years and 88 +/- 3% at 5 years. Cox re gression analysis identified perioperative MI (P = 0.03, relative risk 3.6) as the only prognostic factor for mortality at follow-up. With r egards to recurrence of angina, multivariate analysis has shown that i ncremental risk factors for the return of angina are redo-operation (P < 0.01, relative risk 2.7) and the persistence of hypertension after surgery (P < 0.01; relative risk 3.2), while the use of the RIMA in th e operation has emerged as a protective factor (P = 0.02; relative ris k 0.43). Finally, only redo-operation (P < 0.01; relative risk 2.3), h as emerged as a predictor of cardiac complications. Conclusion: Myocar dial revascularization with at least two arterial grafts can be perfor med with very low perioperative morbidity and mortality and good mid-t erm follow-up. The mid-term results of arterial myocardial revasculari zation are less favourable in cases of redo-operations or when the RIM A is not used. Copyright (C) 1997 Elsevier Science B.V.