Surgical Outcome of Total Arterial Revascularization vs. Conventional Coronary Surgery
Mahmoud El Safty*, M.H. Mazen*, Mona Ramadan**, Khaled El Tohamy***, Mohamed Elasheri*, Waleed Abbass Kamel*, Amr Elprince*
*Department of Cardiac Surgery, National Heart Institute
**Department of Anesthesia, National Heart Institute
***Department of Cardiology, National Heart Institute
Total arterial revascularization confers improved survival benefits 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 centers in the UK for various reasons. A series of patients has been analyzed to assess the feasibility of total arterial revascularization as a primary strategy in patients requiring first time CABG. Methods: 120 patients undergoing first time CABG in National Heart Institute, Egypt, from March 2008 to April 2012, were studied. Group 1 consists of 70 patients undergoing total arterial revascularization (using bilateral internal thoracic or LITA and radial artery) and group 2 consisted of 50 patients undergoing conventional CABG (using LITA and supplemental vein or two veins). Thirty day and late mortality with morbidity in particular reference to cerebrovascular stroke, graft failure, re-CABG, renal failure and dehiscence of sternotomy were the main outcome measures. Results: Patients in group 1 were younger (57 ± 6 vs. 63 ± 4 years, P=0.002), had lower EuroScore, and better left ventricular function. Both groups received a similar number of grafts to LAD and marginal arteries. The percentage of patients under went total arterial revascularization rose from 20 % in the first 24 months to over 75 %, in the later 24 months periods. Overall 30-day mortality was one patient (1.45 %) in group 1 and 3 patients (6 %) in group 2. There was a similar incidence of postoperative complications and length of postoperative hospital stay. Follow up from the 30 day up to the end of follow up showed that mortality was one patient (1.45 %) in group 1 and five patients (10%) in group 2, re-infarction was significantly lowered in group 1, re-CABG also was significantly lowered in group 1. Conclusion: All- arterial bypass grafting is safe and feasible without excess deep sternal wound infections. Late major adverse cardiac events are rare, with low morbidity and mortality. It is a primary strategy in most patients presenting for first time CABG.