Complete myocardial revascularization using arterial grafts

Background: Complete arterial revascularization is important in younger pat ients to reduce the likelihood of future reoperation. We assessed the short -term outcome of a strategy to provide complete arterial revascularization in a cohort of young patients. Methods: Three hundred and eighty-five patients underwent myocardial revasc ularization using artery grafts alone and were followed up for 30 months. O ne hundred fourteen patients (29.6%) had single-vessel disease, 118 (30.6%) had two-vessel disease, and 153 (39.7%,) had three or more obstructed coro nary arteries. Eight of the patients had undergone previous surgical revasc ularization. The left internal thoracic artery (LITA) was routinely used fo r the left anterior descending branch (LAD). In 103 patients (28.1%), the i n situ right internal thoracic artery (RITA) was used for revascularization of the right coronary artery (RCA) and its branches. The RITA was sometime s used as a free graft from the aorta or as an artificial "Y" from the LITA to the diagonal and marginal branches. Other arterial conduits included th e radial artery (RA) in 215 patients (55.8%), the right gastroepiploic arte ry (RGEA) in 24 patients (6.3%), and the inferior epigastric artery (IEA) i n four patients (1.1%). Results: In patients having lesions in three or more arteries, the mean num ber of distal anastomoses was 3.2 per patient. There were no intraoperative deaths. Hospital mortality was 1.8% (n = 7). Of the fatal cases, two were redos and two underwent combined procedures (one for left ventricular aneur ysm and one for double valve replacement), while only three of the fatal ca ses underwent revascularization as a primary and isolated procedure. Conclusions: Complete arterial reconstruction carries an acceptably low ope rative mortality and excellent short-term follow-up. This strategy is parti cularly important for young patients to reduce the probability of future re operation.