Mid-term follow-up of 183 arterial myocardial revascularization procedures.
OBJECTIVE
To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits.


METHODS
From July 1987 to December 1994, 183 patients underwent a myocardial revascularization procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at our institute. Their mean age was 56 +/- 8.7 years, the redo-operation rate was 16.9% (31/183), two-vessel disease was present in 61 patients (33.3%), three-vessel disease in 122 (66.7%).


RESULTS
The LIMA was used in 179 patients (97.8%), the RIMA in 116 (63.4%), the rGEA in 66 (36.1%) and the IEA in 41 (22.4%). In-hospital mortality was 1.1% (2/183), while the perioperative myocardial infarction (MI) rate was 2.2% (4/183). The angiographic restudy, performed on 87 (47.5%) patients during the early postoperative period (median 38 days) showed the following grafts patency rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05 (33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35 months. Kaplan-Meier survival was 96 +/- 2% at 3 and 5 years, freedom from angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-Meier freedom from cardiac events was 90 +/- 3% at 3 years and 88 +/- 3% at 5 years. Cox regression analysis identified perioperative MI (P = 0.03, relative risk 3.6) as the only prognostic factor for mortality at follow-up. With regards to recurrence of angina, multivariate analysis has shown that incremental risk factors for the return of angina are redo-operation (P < 0.01, relative risk 2.7) and the persistence of hypertension after surgery (P < 0.01; relative risk 3.2), while the use of the RIMA in the operation has emerged as a protective factor (P = 0.02; relative risk 0.43). Finally, only redo-operation (P < 0.01; relative risk 2.3), has emerged as a predictor of cardiac complications.


CONCLUSIONS
Myocardial revascularization with at least two arterial grafts can be performed with very low perioperative morbidity and mortality and good mid-term follow-up. The mid-term results of arterial myocardial revascularization are less favourable in cases of redo-operations or when the RIMA is not used.
Antona
C
C
Department of Cardiac Surgery, Centro Cardiologico Fondazione I Monzino IRCCS, University of Milan, Italy.
Zanobini
M
M
Lotto
A A
AA
Parolari
A
A
Alamanni
F
F
Biglioli
P
P
D000206:Actuarial Analysis; D001158:Arteries / Q000637:transplantation*; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005080:Exercise Test; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000601:surgery; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods / Q000401:mortality; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012306:Risk; D014680:Veins / Q000637:transplantation