ABSTRACT
The issue of total arterial revascularization as opposed to conventional coronary artery bypass grafting, using the left internal mammary artery and venous conduits, remains controversial. In this study, we aim to compare both methods in regards to outcome, and short term follow-up. Group I: Forty patients [male 37; female 3; mean age 60 years] underwent CABG using arterial grafts only [left and right internal mammary arteries, and left and right radial arteries]. Data collected were compared with another forty patients [Group II] [male 36; female 4; mean age 65] who were revascularized by conventional CABG using the left internal mammary artery and venous conduits. Patients with single vessel disease, preoperative renal or hepatic dysfunction, or associated cardiac procedures were excluded from the study. There was no statistically significant difference between the groups with respect to systemic hypertension [67.5%], insulin dependent diabetes [6.3%], non-insulin dependent diabetes [25%], hypercholesterolemia [72%], prevalence of three-vessel disease [90%] and left main stenotic lesion [10%], or preoperative ejection fraction [44%].Operative technique and myocardial preservation was similar in both groups. The mean number of grafted vessels per patient was three grafts. All patients were totally revascularized, defined as bypass of all significant lesions with more than 70% stenosis. In all patients in Group II, the left internal mammary artery was anastomosed to the left anterior descending artery, and saphenous vein conduits to the remaining stenosed vessels. In Group I, total arterial revascularization was achieved using the internal mammary. There was no statistically significant difference between both groups regarding early post operative events, inotropic requirements, use of intra-aortic balloon pump, reinterventions for bleeding, wound problems, or stroke. Group I:One patient showed manifestations of postoperative infarction [2.5%]. There were no early mortalities. One patient died five months post-operatively from perforated peptic ulcer. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in a single free right internal mammary artery conduit, and one radial artery conduit. Group II: Three patients showed manifestations of postoperative infarction [7.5%]. There were two early mortalities from heart failure. Five patients were studied postoperatively [8 to 24 months] by coronary angiography revealing graft stenosis in three venous conduits. In this short-term study, there was no significant difference between total arterial revascularization in CABG, and conventional CABG using the left internal mammary artery and venous conduits, in respect to early outcome and graft patency