Total arterial coronary revascularization: Techniques and results in 3,220patients

Background. To overcome the problems of late vein graft atherosclerosis, oc clusion and need of coronary reoperations, we have adopted a strategy of to tal arterial coronary revascularization. We evaluated our experience with t his strategy to establish its safety and efficacy. Methods. All 3,220 consecutive patients who had total arterial coronary rev ascularization from January 1988 to June 1998 were evaluated. Data were col lected prospectively. The mean age was 62.2 years. Of the patients, 595 (18 .8%) had diabetes; 739 (23%) had a left ventricular ejection fraction of le ss than 0.50; and 484 (15%) were classified unstable/urgent. The conduits i ncluded 3,140 left internal thoracic arteries, 1,224 right internal thoraci c arteries, and 2,417 radial arteries, 654 of which were bilateral. A Y or T graft with the left internal thoracic artery was used in 467 patients. Pa tients were followed up at 1 month, 3 months, and yearly thereafter. Postop erative angiography was performed for symptoms or as part of an ethics comm ittee-approved prospective study. Results. The operative mortality rate was 0.7% (21 patients), Complications included stroke in 26 patients (0.8%), myocardial infarction in 27 (0.8%), sternal infection in 35 (1.1%), and reoperation for hemorrhage in 23 (0.7% ). The peak level of the myocardial enzyme of creatine kinase was 16.4 +/- 14.9 IU/L. Twenty-five patients (0.8%) required intraoperative or postopera tive intraaortic balloon pump support. Mortality and stroke rates were high er in patients having reoperation (0.6% versus 1.8%; p = 0.11; and 0.7% ver sus 2.2%; p = 0.07, respectively). Postoperative angiographic patency was 9 7% at 5 years for the left internal thoracic artery (620 grafts), 89% at 5 years for the right internal thoracic artery (276 grafts), and 91% at 1 yea r for the radial artery (65 grafts). Conclusions. Total arterial coronary revascularization can be performed saf ely with good patency rates in a large number of patients and may potential ly avoid the sequelae of vein graft atherosclerosis. (C) 1999 by The Societ y of Thoracic Surgeons.