Total arterial coronary revascularization. Techniques, results and four years follow up in 1,023 consecutive patients

Objective. The main objective of the present study was to analyze the in-ho spital and mid term results obtained in 1,023 consecutive patients undergoi ng coronary artery bypass surgery (CABG) in whom a combination of arterial grafts was used: radial arteries (RA) and one or both internal mammary arte ries (IMA). Methods. From May 1995 to May 1998, 1,023 consecutive patients underwent CA BG alone, using arterial conduits (AC) tone or two IMA and RA) for myocardi al revascularization. The left internal mammary artery (LIMA) was employed as an <<in situ>> graft, and the right internal mammary artery (RIMA) as a free graft or <<in situ>> both in combination with the RA. The latter was c onnected to the LIMA through a T or Y anastomosis, or emerged directly from the ascending portion of the aorta. Results. An average of 3.2 bypasses per patient were performed. The LIMA wa s used in 100% of the patients. The RIMA was used in 21.7% and the RA in 10 0% of the cases. Operative mortality was 2.5% (26 patients) and 32 (3.1%) s uffered perioperative acute myocardial infarction. The first 62 patients we re angiographically re-studied before discharge, and a 98.4% patency of the AC used was found. Mean follow up time was 25.0 +/- 9.6 months (range, 1 t o 48 months). Conclusions. a) myocardial revascularization procedures using a combination of mammary and RA grafts are safe; b) in-hospital and mid term morbidity a nd mortality are not higher than those observed with saphenous vein grafts; c) it is possible to achieve complete myocardial revascularization with on ly AC, even in patients with impaired left ventricular function, and d) AC can be used in elderly patients.