Midterm results of coronary bypass surgery exclusively with arterial revascularization

Introduction and objectives. In recent years, the exclusive use of arterial grafts in coronary surgery has been the surgical option to achieve maximum survival and minimum recurrence of coronary events. The aim of this study was to analyze the surgical results and follow up of this approach. Patients and methods. Over a period of six and a half years, 87 patients un derwent coronary surgery using arterial grafts alone for revascularization. The mean age of the patients was 62 +/- 1 years with 78 men and 9 women; 2 2 patients (25%) were clinically unstable. The number of vessels affected p er patient was 1.83 +/- 0.1, and the number of patients with one, two and t hree affected vessels, were 38 (44%), 26 (30%) and 23 (26%), respectively. The mean ejection fraction was 63 +/- 1.6. Emergency surgery was carried ou t in 13 cases (16%). Results. A total of 1.9 +/- 0.1 grafts were implanted per patient and compl ete revascularization was achieved in 65 cases (75%). The left mammary arte ry was used in 87 cases (100%), the right mammary artery in 31 (35.6%) and the radial artery in 20 cases (23%). Hospital mortality was 1.1% (one case) . During the postoperative period, 3 patients (3.4%) presented myocardial i nfarction, 12 (13.8%) atrial fibrillation and there were 3 cases of sternal dehiscence. A total of 86 patients (98.9%) were followed over a mean period of 24.5 +/- 0.5 months. Survival, angina-free period and period free of any coronary e vent at 5 years were 97 +/- 0.05%, 89 +/- 0.1% and 87 +/- 0.1% respectively (mean i standard error, CI 95%). On multivariate analysis, the presence of peripheral vascular disease (p < 0.015) and the development of low cardiac output (p < 0.04) or atrial fibrillation (p < 0.04) during the postoperati ve period were predictive factors for the appearance of coronary events dur ing follow-up. Conclusions. Surgery exclusively with arterial grafts achieves good medium term results in relation to survival and time free of coronary events.