Complete Arterial Revascularization in Multivessel Coronary Artery Disease With 2 Conduits (Skeletonized Grafts and T Grafts)

Abstract

Background —Complete arterial CABG is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma. By use of new operative techniques (skeletonized grafts and the T-graft approach), CABG in multivessel CAD is now possible with only 2 grafts. We present our experience in the use of these techniques on a routine basis. Methods and Results —Between March 1996 and September 1999, 490 patients (aged 61±9 years, 20% female) underwent complete arterial CABG. Left ventricular ejection fraction ranged from 15% to 85% (mean 59±15%). Triple-vessel disease was present in 88% of the patients. The incidence of diabetes mellitus was 32% (14% insulin dependent). Either both internal thoracic arteries (ITAs) (23%) or the left ITA and radial artery (77%) were used as conduits. In 85% of the patients, a T graft was created. Mean operating time was 198±46 minutes; bypass time, 82±25 minutes; and ischemic time, 58±22 minutes. Two to 7 (mean 4.1±0.9) anastomoses were performed per patient. Perioperative intra-aortic balloon pump was necessary in 12 patients (2.4%). The rate of perioperative myocardial infarction was 1.2%. Sternal complications occurred in 1.0%, and in-hospital mortality was 2.2%. Postoperative coronary angiography in 172 patients (35%) documented excellent patency rates (left ITA 98.3%, right ITA 96.5%, and radial artery 96.6%). Conclusions —Complete arterial revascularization in multivessel CAD is possible with the use of only 2 grafts with good perioperative results. This approach allows for complete arterial CABG on a routine basis.

Is it safe to perform total arterial grafting in elderly patients lacking vein grafts? A single surgeon comparison

“…Furthermore, the exclusive utilization of arterial conduits confers the advantages of enhanced long‐term patency and subsequent improved event‐free survival 6,15–17 . Complete myocardial revascularisation may be accomplished with only two arterial conduits deployed in T‐graft configuration with durable graft patency 5 …”

“…The proximal anastomosis was placed into the ascending aorta in patients in whom the aorta was of adequate quality and the graft of suitable length. In those patients, where this was not the case, the second conduit, SVG or RA, was anastomosed to the LIMA in a T‐graft configuration, as described in detail previously 5 . The procedures were performed with cardiopulmonary bypass.…”

“…In those patients, where this was not the case, the second conduit, SVG or RA, was anastomosed to the LIMA in a T-graft configuration, as described in detail previously. 5 The procedures were performed with cardiopulmonary bypass.…”

“…TA‐CABG, using both ITA's and additional arteries such as the radial arteries (RA), is more complex, and mainly used to improve long‐term results in younger patients <70 years of age. Surgical strategies include T‐grafting and the use of sequential anastomoses 5–12 . and are aimed to avoid the use of SVGs.…”

“…Surgical strategies include T-grafting and the use of sequential anastomoses. [5][6][7][8][9][10][11][12] and are aimed to avoid the use of SVGs. Using these techniques, TA-CABG can be achieved using only two arterial grafts and in similar operation time and with similar morbidity and mortality compared to CO-CABG as the senior author has reported previously.…”