Total arterial revascularisation as a primary strategy for coronary artery bypass grafting

Abstract

Background Bilateral internal thoracic arteries confer improved survival benefit after coronary artery bypass grafting (CABG). Despite increasing evidence, the use of arterial conduits has not been accepted as a primary practice in most of the centres in the UK for various reasons. A series of patients has been analysed to assess the feasibility of total arterial revascularisation as a primary strategy in patients requiring first time CABG. Methods Altogether 245 patients undergoing first time CABG by one surgeon, from June 1999 to October 2000, were studied. Group 1 consisted of 165 patients undergoing total arterial revascularisation (using bilateral internal thoracic and radial arteries) and group 2 consisted of 80 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. Results Patients in group 1 were younger (mean (SD) 60 (10) v 65 (9) years; p<0.001), had lower Parsonnet scores (mean (SD) 5 (5) v 11 (7); p<0.001), and better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularisation rose from 44% in the first three months to over 75% in the three latter three month periods. Overall 30 day mortality was 1.3%, one patient (0.6%) in group 1 and two patients (2.5%) in group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. Conclusion Total arterial revascularisation can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.

Effect of skeletonisation and pedicled bilateral internal mammary artery grafting in coronary artery bypass surgery on post‐operative wound infection: A meta‐analysis

“…One major problem that has been hindering wide use of BIMA transplantation is that surgical wound infection (SWI) may be associated with greater dissection. While it is well known that the traditional PIMA can predict SWI independently, so far no evidence has been published about the risk associated with infection combined with SIMA in the literature, and the large percentage of trials that concentrate on SIMA indicates a possible reduction in the rate of postoperative wound infection 41,42 . Nevertheless, scientists discovered that infection rates were lower in SIMA than in PIMA patients, and there was no statistical significance for SIMA 24 .…”

“…While it is well known that the traditional PIMA can predict SWI independently, so far no evidence has been published about the risk associated with infection combined with SIMA in the literature, and the large percentage of trials that concentrate on SIMA indicates a possible reduction in the rate of postoperative wound infection. 41,42 Nevertheless, scientists discovered that infection rates were…”

Mid-Term Clinical Outcome of Patients Undergoing Coronary Artery Bypass Grafting with Valvulotomized Vein Grafts

“…The Syntax trial has emphasized that CABG should be the standard of treatment for patients with complex lesions, as MACCE was significantly better than PCI in their patient group [Mohr 2013]. Although there is a trend towards full arterial revascularization, the ideal choice for the second graft in CABG is still a controversial issue [Buttar 2017;Naik 2003]. Athanasiou and colleagues presented a meta-analysis of 35 studies that showed a superiority in mid-term (range 51%-97%) and long-term patency (85%-94%) for RA conduits in comparison to SV (59%-91% at mid-term and 64%-91% at long-term), despite similar early patency rates of both conduits (50%-100% for RA and 60%-100% for SV conduits) [Athanasiou 2011].…”

Total Arterial Off-Pump versus On-Pump Coronary Revascularization:. Comparison of Early Outcome

“…Although arterial grafts are increasingly being used in on‐pump coronary artery bypass grafting 5‐8 many surgeons still prefer to use venous grafts in addition to the internal thoracic arteries in the setting of OPCAB revascularization, despite the excellent mid‐term patency rates 10,11 of arterial grafts after OPCAB and associated beneficial long‐term outcome 9,12 . The short‐ and long‐term results of exclusively arterial OPCAB is expected to be equal or even better than exclusively arterial on‐pump CABG, although at present, there is only a very few comparative data concerning early results 13,14 and none on long‐term outcome of patients having been revascularized by completely arterial ONCAB vs. OPCAB.…”

“…Off‐pump coronary artery bypass grafting (OPCAB) has been shown to produce excellent results with low mortality rates and reduced morbidity 1‐4 . Although arterial grafts have been shown to provide superior long‐term outcome compared to saphenous vein grafts (SVG), 5‐9 many surgeons still prefer to use SVGs in addition to IMA grafts in OPCAB surgery. However, CABG patients should not be deprived of these long‐term benefits of arterial grafts because of the short‐term advantages of off‐pump procedures.…”