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Ann Thorac Surg 1999;68:2093-2099
© 1999 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
b Department of Cardiac Surgery, Epworth Hospital, Richmond, University of Melbourne, Melbourne, Australia
Address reprint requests to Dr Tatoulis, Department of Cardiac Surgery, Royal Melbourne Hospital, Suite 28, Private Medical Centre, Melbourne, Victoria 3050, Australia
e-mail: james.tatoulis{at}nwhcn.org.au
Presented at the Poster Session of the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.
Background. To overcome the problems of late vein graft atherosclerosis, occlusion and need of coronary reoperations, we have adopted a strategy of total arterial coronary revascularization. We evaluated our experience with this strategy to establish its safety and efficacy.
Methods. All 3,220 consecutive patients who had total arterial coronary revascularization from January 1988 to June 1998 were evaluated. Data were collected prospectively. The mean age was 62.2 years. Of the patients, 595 (18.8%) had diabetes; 739 (23%) had a left ventricular ejection fraction of less than 0.50; and 484 (15%) were classified unstable/urgent. The conduits included 3,140 left internal thoracic arteries, 1,224 right internal thoracic arteries, and 2,417 radial arteries, 654 of which were bilateral. A Y or T graft with the left internal thoracic artery was used in 467 patients. Patients were followed up at 1 month, 3 months, and yearly thereafter. Postoperative angiography was performed for symptoms or as part of an ethics committee–approved prospective study.
Results. The operative mortality rate was 0.7% (21 patients). Complications included stroke in 26 patients (0.8%), myocardial infarction in 27 (0.8%), sternal infection in 35 (1.1%), and reoperation for hemorrhage in 23 (0.7%). The peak level of the myocardial enzyme of creatine kinase was 16.4 ± 14.9 IU/L. Twenty-five patients (0.8%) required intraoperative or postoperative intraaortic balloon pump support. Mortality and stroke rates were higher in patients having reoperation (0.6% versus 1.8%; p = 0.11; and 0.7% versus 2.2%; p = 0.07, respectively). Postoperative angiographic patency was 97% at 5 years for the left internal thoracic artery (620 grafts), 89% at 5 years for the right internal thoracic artery (276 grafts), and 91% at 1 year for the radial artery (65 grafts).
Conclusions. Total arterial coronary revascularization can be performed safely with good patency rates in a large number of patients and may potentially avoid the sequelae of vein graft atherosclerosis.
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