Total arterial myocardial revascularization (one center experience)
Today gold standard of surgical treatment of ischemic heart disease is coronary artery bypass surgery (or graft, CABG) with the use of left internal thoracic artery (LITA) and great saphenous vein (GSV) of the lower limb.
Objective of the work is to show own experience of performing total arterial myocardial revascularization of patients with isolated multi vascular defeat of coronary artery, in combination with concomitant pathology of the heart valves.
Materials and methods From January 2001 to December 2017 in State Institution «Scientific-Practical Medical Center of Pediatric Cardiology and Cardiac Surgery» Ministry of Health of Ukraine 91 patients were operated, as treatment of ischemic heart disease was performed full arterial vascularization of coronary arteries. All examined patients have two- and more vascular defeat of coronary artery.
Results and discussions. So due to our experience it should be mentioned that two and more arterial conduits CABG is safety, and doesn’t take too much time and could be performed in most patients with ischemic heart disease. According to our data there is no strict contraindications of total arterial myocardial revascularization perfoming. But in five, in ten years should graft potency be tested.
Conclusions. Some patients with traditional contraindications to total arterial myocardial revascularization as: overweight (BMI>35), chronic obstructive pulmonary disease, insulin-dependent diabetes mellitus could have (be performed) optimal type of bypass after additional examination.
2. Olearchyk A. S., Kolesov V. I. A pioneer of coronary revascularization by internal mammary-coronary artery grafting // Journal of Thoracic and Cardiovascular Surgery. – 1988. – Vol. 96, № 1. – P. 13–18.
3. Barner H. B. Double internal mammary-coronary artery bypass // Arch Surg. – 1974. – Vol. 109. – P. 627–630.
4. T-graft: a new method of coronary arterial revascularization/ Tector A. J., Kress D. C., Schmahl T. M. et al. // Cardiovasc Surg (Torino). – 1994. – Vol. 35. – P. 19–23.
5. Total revascularization with T-grafts / Tector A. J., Amundsen S., Schmahl T. M. et al. // Ann Thorac Surg. – 1994. – Vol. 57. – P. 33–38. – discussion 39.
6. Composite arterial conduits for a wider arterial myocardial revascularization / Calafiore A. M., Di Giammarco G., Luciani N. et al. // Ann Thorac Surg. – 1994. – Vol. 90. – P. 58–185.
7. Trends in isolated coronary artery bypass grafting: an analysis of the Siciety of Thoracic Surgeons adult cardiac surgery database / ElBardissi A. W., Aranki S. F., Sheng S. et al. // J Thorac Cardiovasc Surg. – 2012. – Vol. 81. – P. 143–273.
8. Tatoulis J. Total arterial coronary revascularization – patient selection, stenoses, conduits, targets // Ann Cardiothorac Surg. – 2013. – Vol. 2 (4). – P. 499–506.
9. Total Arterial Revascularization: Achievable and Prognostically Effective – A Multicenter Analysis / Tatoulis J., MD, FRACS, Wynne R., Skillington P. D. // Ann Thorac Surg. – 2015. – Vol. 100. – P. 1268–75.
10. Rosengart T. D., MD, FACS. Total arterial revascularization: When wil its time come? // J Thorac Cardiovasc Surg. – 2014. – Vol. 148. – P. 1244–1245.
11. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression / Dimitrova K. R., Hoffman D. M., Geller C. M. et al. // Ann Thorac Surg. – 2012. – Vol. 94. – P. 475–481.
12. Effect of Skeletonization of the internal Thoracic Artery for Coronary Revascularization on Incidence of Sternal Wound Infection / Srdjan S., MBBS, BS, James D. et al. // Ann Thorac Surg. – 2010. – Vol. 89. – P. 661–670.
13. Nikolaos A. Papakonstantinou, MD, Nikolaos G. Baikoussis, MD, PhD. Total arterial revascularization: A superior method of cardiac revascularization // Hellenic Journal of Cardiology. – 2016. – Vol. 57. – P. 152–156.
14. Arterial revascularization in primary coronary artery bypass grafting: Direct comparison of 4 strategies – Result of the Stand-in-Y Mammary Study / Guiseppe N., Roberto C., Raffaele Bonifazi et al. // J Thorac Cardiovasc Surg. – 2009. – Vol. 137. – P. 1093–1100.