Coronary-coronary bypass graft: An arterial conduit–sparing procedure

Abstract

From May 1989 to December 1995, 143 patients underwent myocardial revascularization with one (138 patients) or two (five patients) coronary-coronary bypass grafts in addition to other bypass grafts, for a total of 463 distal anastomoses (mean 3.2 +/- 0.6 per patient). Coronary-coronary bypass grafts were chosen for the following reasons: arterial conduit-sparing procedure, inadequate length for in situ graft, calcified ascending aorta, and stenosed or occluded subclavian arteries. One hundred eleven arterial grafts (75%) were used: 85 right internal thoracic arteries, 18 left internal thoracic arteries, and eight radial arteries. Saphenous vein grafts were used in 37 cases (25%, mostly in our early experience). Coronary-coronary bypass grafts were performed on the right coronary artery in 134 cases (90.5%), on the circumflex artery in five cases (3.3%), on the left anterior descending coronary artery in four cases (2.7%), and between two different coronary arteries in five cases (3.3%). Three patients (2%) died of myocardial infarction. Early postoperative angiography showed a patency rate of 98.6% (72/73). During the mean follow-up of 34.6 +/- 20.8 months, two patients died and two underwent reoperation. Results of exercise testing were normal at 2 months in 97% of patients (90/92), at 1 year in 96% (81/84), and at 3 years in 93% (30/32). In conclusion, the coronary-coronary bypass graft provides good results with a variety of conduits and allows the expanded use of arterial grafts, particularly the internal thoracic artery. This can lead to a sparing of arterial conduit and allow complex myocardial revascularization with a liberal use of internal thoracic arteries.

Revascularization of Left Anterior Descending (LAD) Artery with In Situ Left Internal Thoracic Artery (LITA) and Coronary‐Coronary Free LITA Grafts: 12‐Year Patency

“…Nottin et al reported only three patients with CCBG where ITA (LITA in two, right internal thoracic artery [RITA] in one patient) was used as the conduit in CCBG, LAD‐LAD bypasses. They reported early patency of 98%, six in their series 2 . Nezic et al presented mid‐term follow‐up of a patient with CCBG of LAD with LITA graft after 3.5 years 9 .…”

“…The hemodynamic superiority of CCBG over aortocoronary bypass has been documented by many authors. Proximal anastomoses constructed on the coronary artery itself provide more physiologic diastolic blood flow pattern and less Venturi effect as compared to grafts anastomosed to the aorta or the subclavian artery that are far from the sinuses of Valsalva of the aorta and are unable to use the advantages of the coronary‐prompting effect of the sinuses 1,2 …”

“…CCBG has been widely used in patients with limited conduits with heavily calcified ascending aorta and supraaortic branches. CCBG bypass also avoids the problems of difficult and unsuitable aortic arterial free graft reimplantation in redo surgery 2 . The only prerequisite for CCBG is an undiseased proximal part of the LAD artery which is adequate in diameter.…”

“…The contemporary trend is to use this graft as much as possible in bypasses regardless of the patient's age. ITA has been preferred widely because of its fundamental properties such as resistance to atherosclerosis due to prostacyclin secretion and low vasospastic characteristic, with the additional advantage of greater blood flow in the early postoperative period 2 . Nishida et al were the first to report CCBG operation performed with free ITA graft 6 .…”

Coronary-Coronary Bypass Grafting to Reduce the Risk of Aortic Atheroembolism

“…CCBG was first performed by Rowland and Grooters 6 . In CCBG, the anastomoses are performed between two segments of the same coronary artery or between different coronary arteries 7,8 . Arterial grafts are the first choice for this procedure.…”