Total arterial myocardial revascularization: analysis of initial experience

ABSTRACT

Total arterial myocardial revascularization is an attempt to overcome the problems of late vein graft atherosclerosis, occlusion and need for coronary re-operations. Despite increasing evidence of efficacy, the use of arterial conduits has not been accepted as a primary practice in most of the centers in Pakistan for various reasons. We analyze our initial experience to assess the feasibility of total arterial revascularization as a primary strategy in patients requiring first time coronary artery bypass grafting. METHODS: Two hundred patients undergoing first time CABG at our institution, from January 2000 to April 2001, were studied. Group 1 consisted of 100 patients undergoing total arterial revascularization [using bilateral internal thoracic and radial arteries] and Group 2 consisted of 100 patients undergoing conventional CABG [using one internal thoracic artery and supplemental veins]. Thirty-day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. Patients in Group 1 were younger [56.2 +/- 10.4 vs. 60.3 +/- 9.8 years; P<0.001], had lower Parsonnet scores [4.8 +/- 0.4 vs. 9.6 +/- 1.8; P<0.001], and had better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularization rose from 20% in the first three months to over 65% in the three later three-month periods. Overall 30-day mortality was 1.5%, one patient [1%] in Group 1 and two patients [2%] in Group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. Total arterial revascularization can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity