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Thorac Cardiovasc Surg 2016; 64(03): 197-203
DOI: 10.1055/s-0035-1563670
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Total Arterial Revascularization with Radial Artery T-grafts in Patients with Significant Left Main Stem Stenosis Is Not Associated with Higher Perioperative Risk

Felix Fleissner
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Michael Reitz
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Serghei Cebotari
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Tim Kaufeld
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Axel Haverich
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Malakh Shrestha
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Issam Ismail
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
,
Andreas Martens
1   Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

30 April 2015

07 July 2015

Publication Date:
03 September 2015 (online)

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Abstract

Background Total arterial revascularization (TAR) has become a standard procedure for the treatment of coronary multivessel disease, due to the superior long-term patency rates of arterial grafts as compared with saphenous vein graft material. Controversies about the use of TAR in patients with left main coronary artery disease exist. Hence, we ought to determine whether left main coronary artery disease is a risk factor for early postoperative mortality and morbidity after TAR using the in situ left internal thoracic artery (LITA) and radial artery as composite T-graft.

Methods A total of 904 consecutive patients were included in this retrospective study. They underwent first-time coronary artery bypass grafting surgery in our institution, receiving TAR using the in situ LITA and RA T-graft. Of these patients, 247 (27%) had left main coronary artery disease (Group LMSS) and 657 (73%) had no significant left main coronary artery stenosis (Group nLMSS).

Results Results were comparable. Mortality and perioperative myocardial infarction rates were 0.4% LMSS versus 0.3% nLMSS, p = 1, and 2% LMSS versus 2% nLMSS, p = 0.81, respectively. Stroke rate, acute renal failure rate, and reoperation rates were 2% LMSS versus 1% nLMSS, p = 0.36, 7% LMSS versus 8% nLMSS, p = 0.41, and 2% LMSS versus 3% nLMSS, p = 0.5, respectively. Postoperative stay was shorter in the LMSS group (8.1 ± 4.3 days vs. 8.9 ± 6.1 days nLMSS, p = 0.048).

Conclusion Our perioperative results indicate that TAR in patients with left main stenosis is safe and feasible. Long-term results will have to be awaited to further evaluate prognostic outcome.

Keywords

cardiopulmonary bypass - CABG - total arterial revascularization
 

  • References

  • 1 Georghiou GP, Vidne BA, Dunning J. Does the radial artery provide better long-term patency than the saphenous vein?. Interact Cardiovasc Thorac Surg 2005; 4 (4) 304-310
    CrossrefPubMedGoogle Scholar
  • 2 Locker C, Schaff HV, Dearani JA , et al. Multiple arterial grafts improve late survival of patients undergoing coronary artery bypass graft surgery: analysis of 8622 patients with multivessel disease. Circulation 2012; 126 (9) 1023-1030
    CrossrefPubMedGoogle Scholar
  • 3 Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004; 77 (1) 93-101
    CrossrefPubMedGoogle Scholar
  • 4 Di Giammarco G, Vitolla G, Di Mauro M, Calafiore AM. Arterial revascularisation with two or more arterial conduits. Heart Lung Circ 2000; 9 (3) 108-112
    CrossrefPubMedGoogle Scholar
  • 5 Wendler O, Hennen B, Demertzis S , et al. Complete arterial revascularization in multivessel coronary artery disease with 2 conduits (skeletonized grafts and T grafts). Circulation 2000; 102 (19) (Suppl. 03) III79-III83
    PubMedGoogle Scholar
  • 6 Ronald A, Patel A, Dunning J. Is the Allen's test adequate to safely confirm that a radial artery may be harvested for coronary arterial bypass grafting?. Interact Cardiovasc Thorac Surg 2005; 4 (4) 332-340
    CrossrefPubMedGoogle Scholar
  • 7 Lytle BW, Loop FD, Taylor PC , et al. Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries. J Thorac Cardiovasc Surg 1992; 103 (5) 831-840
    PubMedGoogle Scholar
  • 8 Reardon MJ, Conklin LD, Reardon PR, Baldwin JC. Coronary artery bypass conduits: review of current status. J Cardiovasc Surg (Torino) 1997; 38 (3) 201-209
    PubMedGoogle Scholar
  • 9 Desai ND, Cohen EA, Naylor CD, Fremes SE ; Radial Artery Patency Study Investigators A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med 2004; 351 (22) 2302-2309
    CrossrefPubMedGoogle Scholar
  • 10 Barner HB, Sundt III TM. Multiple arterial grafts and survival. Curr Opin Cardiol 1999; 14 (6) 501-505
    CrossrefPubMedGoogle Scholar
  • 11 Collins P, Webb CM, Chong CF, Moat NE ; Radial Artery Versus Saphenous Vein Patency (RSVP) Trial Investigators. Radial artery versus saphenous vein patency randomized trial: five-year angiographic follow-up. Circulation 2008; 117 (22) 2859-2864
    CrossrefPubMedGoogle Scholar
  • 12 Carpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts. Ann Thorac Surg 1973; 16 (2) 111-121
    CrossrefPubMedGoogle Scholar
  • 13 Acar C, Jebara VA, Portoghese M , et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992; 54 (4) 652-659 , discussion 659–660
    CrossrefPubMedGoogle Scholar
  • 14 Hayward PA, Hare DL, Gordon I, Matalanis G, Buxton BF. Which arterial conduit? Radial artery versus free right internal thoracic artery: six-year clinical results of a randomized controlled trial. Ann Thorac Surg 2007; 84 (2) 493-497 , discussion 497
    CrossrefPubMedGoogle Scholar
  • 15 Tector AJ, Amundsen S, Schmahl TM, Kress DC, Peter M. Total revascularization with T grafts. Ann Thorac Surg 1994; 57 (1) 33-38 , discussion 39
    CrossrefPubMedGoogle Scholar
  • 16 Chardigny C, Jebara VA, Acar C , et al. Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery. Circulation 1993; 88 (5, Pt 2) II115-II127
    PubMedGoogle Scholar
  • 17 Akasaka T, Yoshikawa J, Yoshida K , et al. Flow capacity of internal mammary artery grafts: early restriction and later improvement assessed by Doppler guide wire. Comparison with saphenous vein grafts. J Am Coll Cardiol 1995; 25 (3) 640-647
    CrossrefPubMedGoogle Scholar
  • 18 Shrestha M, Bara C, Khaladj N , et al. Intraoperative bypass graft angiography: cooperation between cardiologist and surgeons in the operation room for optimal postoperative results — is this the way for the future?. Thorac Cardiovasc Surg 2007; 55 (6) 355-358
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Shrestha M, Khaladj N, Kamiya H, Maringka M, Haverich A, Hagl C. Total arterial revascularization and concomitant aortic valve replacement. Asian Cardiovasc Thorac Ann 2007; 15 (5) 381-385
    CrossrefPubMedGoogle Scholar
  • 20 Affleck DG, Barner HB, Bailey MS , et al. Flow dynamics of the internal thoracic and radial artery T-graft. Ann Thorac Surg 2004; 78 (4) 1290-1294 , discussion 1290–1294
    CrossrefPubMedGoogle Scholar
  • 21 Maniar HS, Barner HB, Bailey MS , et al. Radial artery patency: are aortocoronary conduits superior to composite grafting?. Ann Thorac Surg 2003; 76 (5) 1498-1503 , discussion 1503–1504
    CrossrefPubMedGoogle Scholar
  • 22 Kolh P, Windecker S, Alfonso F , et al; European Society of Cardiology Committee for Practice Guidelines; EACTS Clinical Guidelines Committee; Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery; European Association of Percutaneous Cardiovascular Interventions. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2014; 46 (4) 517-592
    CrossrefPubMedGoogle Scholar
  • 23 Buszman PE, Kiesz SR, Bochenek A , et al. Acute and late outcomes of unprotected left main stenting in comparison with surgical revascularization. J Am Coll Cardiol 2008; 51 (5) 538-545
    CrossrefPubMedGoogle Scholar
  • 24 Park S-J, Kim Y-H, Park D-W , et al. Randomized trial of stents versus bypass surgery for left main coronary artery disease. N Engl J Med 2011; 364 (18) 1718-1727
    CrossrefPubMedGoogle Scholar
  • 25 Serruys PW, Morice M-C, Kappetein AP , et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
    CrossrefPubMedGoogle Scholar