J Tatoulis1, B F Buxton, J A Fuller. 1. Department of Cardiac Surgery, Royal Melbourne Hospital, University of Melbourne, Victoria, Australia. kathie.vezzoso@whcn.org.au
Abstract
BACKGROUND: To achieve arterial myocardial revascularization we have progressively used more single and bilateral internal thoracic artery and radial artery (RA) grafts. We evaluated our early experience with bilateral radial artery to coronary grafts. METHODS: As part of their coronary reconstruction, 261 patients had 522 bilateral RA grafts from March 1995 to June 1997. Mean age was 61.1 years. There were 70 (27%) patients with non-insulin-dependent diabetes and 13 (5%) with insulin-dependent diabetes. Unstable angina was seen in 54 (21%) patients. Left ventricular ejection fraction less than 50% was noted in 74 (28.4%) patients. Coronary revascularization was completed with additional single internal thoracic artery in 229 patients (88%), bilateral internal thoracic artery in 25 patients (9.6%), and vein grafts in 13 patients (5%). Intraluminal 1% papaverine in blood was used. There were 3.6 +/- 0.7 distal anastomoses per patient, with a total of 939, 921 (98%) with arterial conduits and 18 with vein grafts. Five hundred ninety-four (63%) of the anastomoses were with RAs. Of the 522 RA grafts 72 (13.8%) were used sequentially. The RA was most frequently placed to the circumflex marginals (261 patients, 100%) and posterior descending (169 patients, 65%). Proximal RA anastomosis was directly to the aorta in 472 patients, the internal thoracic artery in 42, or another RA in 8. All anastomoses were constructed during a single cross-clamp period (mean, 74.2 +/- 26.6 minutes). RESULTS: Operative mortality was 2 patients (0.8%). Complications included stroke in 2 patients (0.8%), deep internal infection in 2 (0.8%), reoperation for hemorrhage in 1 (0.4%), and myocardial infarction in 2 (0.8%). Mean peak creatine kinase-MB was 13.2 +/- 11.6 IU/L. There were no forearm infections or hand ischemia, but there were 4 (1.6%) hematomas, 1 requiring drainage. Angiography was done on 16 patients with RA grafts, a mean of 4.2 months postoperatively. Twenty of 22 distal anastomoses were patent (91%), and there was 1 occlusion and 1 string sign. CONCLUSIONS: Bilateral RA to coronary grafting extends the scope of arterial myocardial revascularization, and is safe. Late angiographic results are required.
BACKGROUND: To achieve arterial myocardial revascularization we have progressively used more single and bilateral internal thoracic artery and radial artery (RA) grafts. We evaluated our early experience with bilateral radial artery to coronary grafts. METHODS: As part of their coronary reconstruction, 261 patients had 522 bilateral RA grafts from March 1995 to June 1997. Mean age was 61.1 years. There were 70 (27%) patients with non-insulin-dependent diabetes and 13 (5%) with insulin-dependent diabetes. Unstable angina was seen in 54 (21%) patients. Left ventricular ejection fraction less than 50% was noted in 74 (28.4%) patients. Coronary revascularization was completed with additional single internal thoracic artery in 229 patients (88%), bilateral internal thoracic artery in 25 patients (9.6%), and vein grafts in 13 patients (5%). Intraluminal 1% papaverine in blood was used. There were 3.6 +/- 0.7 distal anastomoses per patient, with a total of 939, 921 (98%) with arterial conduits and 18 with vein grafts. Five hundred ninety-four (63%) of the anastomoses were with RAs. Of the 522 RA grafts 72 (13.8%) were used sequentially. The RA was most frequently placed to the circumflex marginals (261 patients, 100%) and posterior descending (169 patients, 65%). Proximal RA anastomosis was directly to the aorta in 472 patients, the internal thoracic artery in 42, or another RA in 8. All anastomoses were constructed during a single cross-clamp period (mean, 74.2 +/- 26.6 minutes). RESULTS: Operative mortality was 2 patients (0.8%). Complications included stroke in 2 patients (0.8%), deep internal infection in 2 (0.8%), reoperation for hemorrhage in 1 (0.4%), and myocardial infarction in 2 (0.8%). Mean peak creatine kinase-MB was 13.2 +/- 11.6 IU/L. There were no forearm infections or hand ischemia, but there were 4 (1.6%) hematomas, 1 requiring drainage. Angiography was done on 16 patients with RA grafts, a mean of 4.2 months postoperatively. Twenty of 22 distal anastomoses were patent (91%), and there was 1 occlusion and 1 string sign. CONCLUSIONS: Bilateral RA to coronary grafting extends the scope of arterial myocardial revascularization, and is safe. Late angiographic results are required.
Authors: John Lin; Wen Cheng; Lawrence S Czer; Michele A De Robertis; James Mirocha; Andrea Ruzza; Robert M Kass; Ali Khoynezhad; Danny Ramzy; Fardad Esmailian; Alfredo Trento Journal: J Am Heart Assoc Date: 2013-08-22 Impact factor: 5.501