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; Michael Reitz; Serghei Cebotari; Tim Kaufeld; Axel Haverich; Malakh Shrestha; Issam Ismail; Andreas Martens

doi:10.1055/s-0035-1563670

The Thoracic and Cardiovascular Surgeon, Table of Contents

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

Authors

Felix Fleissner

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Michael Reitz

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Serghei Cebotari

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Tim Kaufeld

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Axel Haverich

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Malakh Shrestha

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Issam Ismail

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
Andreas Martens

¹Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany

Abstract

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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

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References

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