Total Arterial Myocardial Revascularization on a Beating Heart in Patients with Atherosclerotic Damage of Coronary Vessels

  • A. Gabriyelyan State institute “Shalimov’s National Institute of Surgery and Transplantation” to National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine http://orcid.org/0000-0002-4141-5902
  • A. Mazur State institute “Shalimov’s National Institute of Surgery and Transplantation” to National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine http://orcid.org/0000-0002-6873-7573
  • V. Beleyovych State institute “Shalimov’s National Institute of Surgery and Transplantation” to National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  • T. Domansky State institute “Shalimov’s National Institute of Surgery and Transplantation” to National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  • S. Chaikovska State institute “Shalimov’s National Institute of Surgery and Transplantation” to National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine http://orcid.org/0000-0001-9847-7760
DOI: https://doi.org/10.30702/ujcvs/20.4009/036009-014/166
Keywords: coronary artery bypass surgery on a beating heart, off-pump technique, total arterial revascularization, internal thoracic artery, radial artery, right gastroepiploic artery

Abstract

Introduction. One of the main unresolved problems in coronary surgery has been the search for an “ideal” graft for coronary artery bypass surgery. Surgical procedures with the use of artificial circulation can lead to high incidence of postoperative complications compared to operations on a beating heart.

The aim. To study the results of total arterial myocardial revascularization on a beating heart and to evaluate the medium-term outcomes in patients with coronary heart disease.

Materials and methods. Ninety eight patients with coronary heart disease were treated from 2009 to 2013. The patients underwent total arterial myocardial revascularization on a beating heart using only arterial grafts: those obtained from internal thoracic artery, radial artery, and right gastroepiploic artery.

Results and discussion. No deaths were observed in the postoperative period. In 91 (92.8%) patients, the postoperative period was uneventful. After 5 years of follow-up, clinical and non-invasive methods of examination revealed no coronary circulation disorders.

Conclusions. Our clinical experience showed promising short- and medium-term results. The technique of total arterial myocardial revascularization on a beating heart is a good alternative to operations performed under the condition of artificial circulation.

References

  1. Taggart DP, Benedetto U, Gerry S, Altman DG, Gray AM, Lees B, et al. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. N Engl J Med. 2019 Jan; 380(5):437-46. https://doi.org/10.1056/NEJMoa1808783
  2. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al.; Authors/Task Force members. 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 Heart J. 2014;35(37):2541-619. https://doi.org/10.1093eurheartj/ehu278.
  3. Akita S, Tajima K, Kato W, Tanaka K, Goto Y, YamamotoR, et al. The long-term patency of a gastroepiploic artery bypass graft deployed in a semiskeletonized fashion: predictors of patency. Interact Cardiovasc Thorac Surg. 2019 Jun 1;28(6):868-75. PMID: 30649384. https://doi.org/10.1093/icvts/ivy346.
  4. Edelman JJ, Sherrah AG, Wilson MK, Bannon PG, Brereton RJ, Ross DE, et al. Anaortic, total-arterial, off-pump coronary artery bypass surgery: whybother? Heart Lung Circ. 2013;22(3):16170. https://doi.org/10.1016/j.hlc.2012.09.005.
  5. Guo-Wei He, editor. Arterial grafting for coronary artery bypass surgery. Berlin: Springer-Verlag; 2006. https:/doi.org/10.1007/3-540-30084-8
  6. Samak M, Fatullayev J, Sabashnikov A, Zeriouh M, Schmack B, Ruhparwar A, et al. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease. Med Sci Monit Basic Res. 2016;22:107-14. https://doi.org/10.12659/msmbr.901508
  7. Suma H. The Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting: A 30-Year Experience. Korean J Thorac Cardiovasc Surg. 2016 Aug;49(4):225-31. https://doi.org/10.5090/kjtcs.2016.49.4.225
  8. Руденко АВ, Урсуленко ВИ, Купчинский АВ, Береговой АА, Витовский РМ, Руденко НЛ. Обобщение 14-летнего опыта выполнения операций коронарного шунтирования на работающем сердце. Вісник серцево-судинної хірургії. 2014;(22):301-6.
  9. Rudenko AV, Ursulenko VI, Kupchinskiy AV, Beregoviy AA, Vitovskyi RM, Rudenko ML. [Summarizing 14-year Experience of Off-Pump Coronary Artery Bypass Grafting Surgery]. Ukrainian Journal of Cardiovascular Surgery. 2014;(22):301-6. Ukrainian.
  10. Suzuki T, Asai T, Nota H, Kuroyanagi S, Kinoshita T, Takashima N, et al. Early and long-term patency of in situ skeletonized gastroepiploic artery after off-pump coronary artery bypass graft surgery. Ann Thorac Surg. 2013;96(1):90-5. https://doi.org/10.1016/jathoracsur.2013.04.018
  11. Deppe AC, Arbash W, Kuhn EW, Slottosch I, Scherner M, Liakopoulos OJ, et al. Current evidence of coronary artery bypass grafting off-pump versus on-pump: a systematic review with meta-analysis of over 16,900 patients investigated in randomized controlled trials. Eur J Cardiothorac Surg. 2016;49(4):1031-41. https://doiorg/10.1093/ejcts/ezv268
  12. Taggart DP, Amin S, Djordjevic J, Oikonomou EK, Thomas S, Kampoli AM, et al. A prospective study of external stenting of saphenous vein grafts to the right coronary artery: the VEST II study. Eur J Cardiothorac Surg. 2017 May 1;51(5):952-8. https://doi.org/10.1093/ejcts/ezw438
  13. Bisleri G, Di Bacco L, Giroletti L, Muneretto C. Total arterial grafting is associated with improved clinical outcomes compared to conventional myocardial revascularization at 10 years follow-up. Heart Vessels. 2017;32(2):109-16. https://doi.org/10.1007/s00380-016-0846-6
  14. Taggart DP, Altman DG, Flather M, Gerry S, Gray A, Lees B, et al. Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes: Insights From the Arterial Revascularization Trial. Circulation. 2017;136(5):454-63. https://doiorg/10.1161/CIRCULATIONAHA.117.027659
  15. Papakonstantinou N, Baikoussis N. Total arterial revascularization: A superior method of cardiac revascularization. Hellenic J. Cardiol. 2016;57(3):152-6. https://doi.org/10.1016/j.hjc.2016.06.002
  16. Tatoulis J, Buxton BF, Fuller JA, Meswani M, Theodore S, Powar N, et al. Long-term patency of 1108 radial arterial-coronary angiograms over 10 years. Ann Thorac Surg. 2009;88(1):23-9. https://doi.org/10.1016/jathoracsur.2009.03.086
  17. Cao C, Manganas C, Horton M, Bannon P, Munkholm-Larsen S, Ang SC, et al. Angiographic outcomes of radial artery versus saphenous vein in coronary artery bypass graft surgery: A meta-analysis of randomized controlled trials. J Thorac Cardiovasc Surg, 2013;146(2):255-61. https://doi.org/10.1016/j.jtcvs.2012.07.014
  18. Arutyunyan VB. [Radial artery as an alternative conduit in the surgical treatment of coronary artery disease [dissertation]. Moscow;2009.
Published
2020-09-18
How to Cite
Gabriyelyan, A., Mazur, A., Beleyovych, V., Domansky, T., & Chaikovska, S. (2020). Total Arterial Myocardial Revascularization on a Beating Heart in Patients with Atherosclerotic Damage of Coronary Vessels. Ukrainian Journal of Cardiovascular Surgery, (3 (40), 9-14. https://doi.org/10.30702/ujcvs/20.4009/036009-014/166
Issue
Ukrainian Journal of Cardiovascular Surgery No 3 (40) 2020
Section
ISCHEMIC HEART DISEASE

Most read articles by the same author(s)