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 characterized by better long-term patency results and outcomes such as fewer incidence of myocardial infarctions and angina, lower incidence of reintervention, lower associated mortality rates and longer late survival and better quality of life than the traditional coronary artery bypass grafting (CABG).
Considering the participants were young at enrollment, and most of them were in a good physical state without severe history of diseases, total arterial revascularization was performed to maximize the efficacy of CABG procedures and reduce the adverse effects caused by using one or more great saphenous veins grafts.
The study reported here the efficacy and outcomes of total arterial coronary artery bypass grafting in 35 patients with non-single-vessel coronary artery diseases.
There are a variety of grafting techniques for arterial revascularization. The study selected three major strategies: left internal mammary artery (LIMA), radial artery (RA) and right gastroepiploic artery (RGEA) grafting. Thirty-five patients with non-single-vessel coronary artery diseases underwent CABG operation receiving the three kinds of grafts based on their physical conditions. Specifically, a total 90 vessels were grafted with an average of 2.6 vessels per person. Thirty-five patients received LIMA grafts, 35 patients received RA grafts and 9 patients received RGEA grafts. Perioperative complications and patency were observed, and quality of life was followed-up.
Patients undergoing total arterial revascularization resulted in improved clinical outcomes. All the patients were discharged from hospitals without occurrence of deaths. Over the follow-up, no occlusion was discovered for LIMA graft and occlusion of RA and RGEA grafts was low without severe postoperative complications.
In spite of technical difficulty associated with the harvest of LIMA, RA and RGEA, total arterial revascularization provided favorable results especially in the aspect of anastomoses and patency compared with commonly used veins as grafts, which are more likely than artery grafts to develop plaque and become blocked over time.
The usage of total arterial revascularization is restricted by several factors such patient age and general health, history of other diseases and conditions. For instance, it should be avoided in patients with insulin-dependent diabetics, or in patients with severe chronic obstructive pulmonary disease because they are at a high risk of developing sternal wound infections and the availability of conduits was constrained. More real-world studies should be conducted to determine the individuated revascularization strategies in this population.