Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5073
Peer-review started: February 25, 2021
First decision: April 4, 2021
Revised: April 19, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: July 6, 2021
Processing time: 118 Days and 22.1 Hours
Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery (CABG), in which the left internal mammary artery (LIMA) is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used. This study determined whether these favorable clinical results could be realized at the authors’ institute.
To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.
CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019. LIMA was used in 35 patients, radial artery (RA) was used in 35 patients, and right gastroepiploic artery (RGEA) was used in 9 patients. Perioperative complications were observed, short-term graft patency rate was followed-up, and quality of life was assessed.
All patients underwent off-pump coronary artery bypass and the surgeries were successful. All of them were discharged without any complications or deaths. During the follow-up, it was found that patients’ angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II. A total of 90 vessels were grafted with no occlusion for internal mammary artery, three occlusions for RA, and one occlusion for RGEA.
The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.
Core Tip: To determine whether total arterial revascularization is superior to conventional coronary artery bypass surgery (CABG), we observed the efficacy and clinical outcomes in patients receiving three major arterial grafts during arterial revascularization surgery. All patients were discharged without occurrence of death. Over a follow-up of 3 mo to 1 year, the number of anastomoses was high, the graft occlusion rate was low, and no severe complications occurred. The use of arterial conduits generally provides significantly better late survival especially in patients with multi-vessel coronary disease, cardiac event-free survival and improved health-related quality of life compared to conventional CABG.