Comparative Analysis of Early Postoperative Period in Patients with Total Arterial Revascularization and Conventional Coronary Artery Bypass Grafting

Keywords: internal thoracic artery, great saphenous vein, risk factors, diabetes, wound complications

Abstract

The use of total arterial myocardial revascularization in patients with multivessel lesions of the coronary arteries has a number of advantages, namely the duration of functioning or patency of the grafts. The level of total arterial myocardial revascularization implementation in developed and developing countries remains quite low.

The aim. Based on the analysis of our own experience, to determine the influence of the technique of total arterial revascularization on the frequency of complications in the early postoperative period.

Materials and methods. From February 22, 2016 to December 24, 2020, 390 consecutive patients were operated at the Ukrainian Children’s Cardiac Center. The patients were divided into two groups: participants of the group I underwent total arterial myocardial revascularization, and those includedin the group II underwent conventional coronary artery bypass grafting (CABG). The inclusion criteria were: ischemic heart disease, stable angina or exertional angina, multivascular coronary artery disease, absence of valvular pathology.

Results. There was zero 30-day mortality in both groups. The frequency of postoperative bleeding was higher in group II and amounted to 1.6%. Surgical wound complications (infection) were also more common in the group II: 1.2% versus 0.69% (p=0.906) in the group I. Similarly, laboratory parameters such as the level of creatine kinase-MB were almost identical.

Conclusions. Total arterial myocardial revascularization is a safe method with good immediate results. The frequency of complications in total arterial myocardial revascularizationdoes not differ from that in conventional CABG. For a wider application of the total arterial myocardial revascularization,it is necessary to continue toconduct studies of the remote postoperative period.

References

  1. Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, Di Giammarco G, et al.; ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation. 2017;136(18):1749-64. https://doi.org/10.1161/CIRCULATIONAHA.117.027597
  2. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018;10(3):1960-7. https://doi.org/10.21037/jtd.2018.02.43
  3. Anyanwu AC, Adams DH. Total Arterial Revascularization for Coronary Artery Bypass: A Gold Standard Searching for Evidence and Application. J Am Coll Cardiol. 2018;72(12):1341-5. https://doi.org/10.1016/j.jacc.2018.07.035
  4. Grieshaber P, Oster L, Schneider T, Johnson V, Orhan C, Roth P, et al. Total arterial revascularization in patients with acute myocardial infarction - feasibility and outcomes. J Cardiothorac Surg. 2018;13(1):2. https://doi.org/10.1186/s13019-017-0691-4
  5. Garg AX, Badner N, Bagshaw SM, Cuerden MS, Fergusson DA, Gregory AJ, et al.; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group. Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial. J Am Soc Nephrol. 2019;30(7):1294-304. https://doi.org/10.1681/ASN.2019010004
  6. Leonard JR, Abouarab AA, Taggart DP, Gaudino MFL. Bilateral internal thoracic artery use in coronary bypass surgery: is there a bene?it? Indian J Thorac Cardiovasc Surg. 2018;34(Suppl 3):230-3. https://doi.org/10.1007/s12055-018-0693-4
  7. Boodhwani M, Lam BK, Nathan HJ, Mesana TG, Ruel M, Zeng W, et al. Skeletonized Internal Thoracic Artery Harvest Reduces Pain and Dysesthesia and Improves Sternal Perfusion After Coronary Artery Bypass Surgery: A Randomized, Double-Blind, Within-Patient Comparison. Circulation. 2006;114(8):766-73. https://doi.org/10.1161/CIRCULATIONAHA.106.615427
  8. Tector AJ, Amundsen S, Schmahl TM, Kress DC, Peter M. Total Revascularization With T Grafts. Ann Thorac Surg. 1994;57(1):33-8; discussion 39. https://doi.org/10.1016/0003-4975(94)90361-1
  9. Taggart DP. The role of multiple arterial grafts during CABG: at the heart of ART. Indian J Thorac Cardiovasc Surg. 2019;35(4):525-7. https://doi.org/10.1007/s12055-019-00828-9
  10. Ryan CT, Schutz A, Rosengart TK. Right for the Wrong Reasons: Implications of Data Insuf?iciency in Bilateral Versus Single Internal Thoracic Artery Grafting Analysis. J Am Heart Assoc. 2018;7(1):e008262. https://doi.org/10.1161/JAHA.117.008262
  11. Gaudino MFL, Taggart DP, Fremes SE. The ROMA trial: why it is needed. Curr Opin Cardiol. 2018;33(6):622-6. https://doi.org/10.1097/HCO.0000000000000565
  12. Bragazzi NL, Zhong W, Shu J, Abu Much A, Lotan D, Grupper A, et al. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol. 2021;28(15):1682-90. https://doi.org/10.1093/eurjpc/zwaa147
  13. Taggart DP. Implications of the 10-year outcomes of the Arterial Revascularization Trial (ART) for multiple arterial grafts during coronary artery bypass graft. Eur J Cardiothorac Surg. 2019;56(3):427-8. https://doi.org/10.1093/ejcts/ezz174
  14. Naito R, Miyauchi K. Coronary Artery Disease and Type 2 Diabetes Mellitus. Int Heart J. 2017;58(4):475-80. https://doi.org/10.1536/ihj.17-191
  15. Lv M, Gao F, Liu B, Pandey P, Feng Y, Wang Y, et al. The Effects of Obesity on Mortality Following Coronary Artery Bypass Graft Surgery: A Retrospective Study from a Single Center in China. Med Sci Monit. 2021;27:e929912. https://doi.org/10.12659/MSM.929912
Published
2022-12-26
How to Cite
Pukas, O. Y., & Rudenko, N. M. (2022). Comparative Analysis of Early Postoperative Period in Patients with Total Arterial Revascularization and Conventional Coronary Artery Bypass Grafting. Ukrainian Journal of Cardiovascular Surgery, 30(4), 33-38. https://doi.org/10.30702/ujcvs/22.30(04)/RP049-3338