The subclavian and axillary arteries as inflow vessels for coronary arterybypass grafts - Combined experience from three cardiac surgery centers

BACKGROUND: The subclavian and axillary arteries represent reliable inflow vessels in peripheral vascular surgery. During recent years they have also been used for special situations in coronary artery bypass grafting. We rep ort on a preliminary, triple center experience with subclavian/axillary art ery to coronary artery bypass grafting. METHODS: Twenty-one patients (11 male, 10 female, median age 70 years) rece ived subclavian artery/axillary artery to coronary artery bypass grafts. In dications for application of this bypass variation were internal mammary ar tery problems during minimally invasive coronary artery bypass grafting (n = 10), untouchable ascending aorta (n = 6), high risk reoperations (n = 3), severe chronic obstructive pulmonary disease (COPD) (n = 1) and right vent ricular ischemia after ascending aortic replacement for acute aortic dissec tion type A (n = 1). Fourteen procedures were carried out via minithoracoto my, and seven via sternotomy. Inflow vessels were the left subclavian/axill ary artery in 12 cases, the right subclavian/axillary artery in eight cases and bilateral subclavian/axillary artery in one case. Bypass conduits were the saphenous vein (n = 20 for revascularization of the left anterior desc ending artery, the right coronary artery and obtuse marginal branches) and the radial artery (n = 2 for revascularization of diagonal branches). RESULTS: The procedure was without major technical problems in all patients . Hospital mortality was 1/21. Neither brachial plexus injury nor arm ische mia occurred. Mean pre- and postoperative angina classification was 3.0 +/- 0.8 and 1.2 +/- 0.4 respectively (p < 0.001). After a mean follow-up perio d of seven months, one out of 14 axillocoronary vein grafts studied by ultr asonic duplex scan or angiography was found occluded. Graft patency could b e demonstrated for an observation period of up to two years. CONCLUSION: Subclavian/axillary artery to coronary artery bypass is feasibl e and can be applied for complications in minimally invasive coronary arter y bypass grafting, for redo operations and for management of the severely a therosclerotic ascending aorta. To reach the left anterior descending arter y-system, the saphenous vein as well as the radial artery can be used. Comp lications concerning the infraclavicular incision seem to be no problem. Sh ort-term patency rates are acceptable.