Myocardial Revascularization with Multiple Arterial Grafts

Abstract

From October 1991 10 July 1994, 439 patients underwent elective or urgent coronary artery bypass grafting utilizing 2 or more arterial conduits. Age ranged from 28 to 79 years (mean, 62.3 years). Most of the patients had 3-vessel disease (301); the remaining had 2-vessel (120) or 1-vessel (18) disease. A stenosis of the left main trunk greater than or equal to 50% was present in 73 patients; in 16 cases it was a redo operation. The left ventricular ejection fraction ranged from 0.19 to 0.84 (mean, 0.53). We utilized 1110 arterial conduits (430 left internal mammary arteries, 259 right internal mammary arteries, 136 right gastroepiploic arteries, 120 inferior epigastric arteries, 165 radial arteries) together with 113 saphenous veins (2.63 arterial anastomoses per patient, ranging from 2 to 6). In 347 patients (79%) we performed a complete arterial myocardial revascularization with an average of 2.80 anastomoses per patient. Two arterial conduits were used in 245 patients, 3 in 163, 4 in 30, and 5 in 1 patient. The myocardial protection was achieved by means of intermittent antegrade warm blood cardioplegia. The mean cross-clamping time was 47.3 ± 16 minutes (range, 16 to 142 minutes). Five patients (1.1%) died in the postoperative period, none were in the operating theater. The causes of death were cardiac (2), sepsis (1), pneumonia (1) and pancreatic necrosis (1). In 7 patients (1.6%) a perioperative myocardial necrosis occurred without any hemodynamic sequelae. Out of 430 patients alive, 419 (97.4%) are asymptomatic. At the postoperative angiographic control all the arterial grafts explored showed complete patency; the midterm angiography (mean, 14 months) revealed a cumulative patency of 96% (range, 100% for the left internal thoracic artery to 94.1% for the radial artery). We conclude that on the basis of the early results the technique herein described is effective and reproducible, even if long-term follow-up is needed to confirm these data.