title: [Total arterial myocardial revascularization with both mammary arteries without extracorporeal circulation].
abstract: BACKGROUND
  Tector has described the off-pump total arterial revascularization technique, using multiple anastomosis with both internal thoracic arteries. To reduce surgical morbid-mortality, we have proposed the use of this technique without extracorporeal circulation.
  
  
  METHODS
  From April, 1998 the off-pump <<Tector>> technique was performed in 92 patients, 74 male (80%) and 18 female (20%), with a mean age of 64.9+/-8.1 years (42-78). Preoperative angiography demonstrated triple-vessel disease in 58 (63%) patients, and left main disease was present in 19 (20.5%) patients. Forty patients (43.5%) showed unstable angina, 24 patients (26%) significant peripheral vascular disease, and 26 (28%) diabetes mellitus. Both internal thoracic arteries were harvested using the skeletonization technique and were used like a <<T or T>> graft. The flow in the graft was measured using a flowmeter, and in 24 (26%) patients by angiographic study.
  
  
  RESULTS
  A total of 274 distal anastomoses were performed, 122 (44.6%) in the lateral or inferior wall, and 69 (25.2%) were sequential, with an average of 2.98 bypass/patient. In 59.8% of the patients a triple bypass was performed, 22% double bypass, 17% cuadruple bypass and 1 patient a quintuple bypass. During the initial six hours 64.9% of patients were extubated. Only one patient (1.1%) needed intraaortic ballon pumping and 3 (3.2%) inotropics during the postoperative course. Hospital mortality was 3 (3.2%) patients. Reoperation for bleeding was needed in just one patient (1.1%), and 78.3% of patients were not transfused. Mediastinitis occurred in 3 patients (3.2%). Postoperative stroke was not observed. At 7.7+/-2.8 months of mean follow-up all patients were free of symptoms and the global patency rate of 94%.
  
  
  CONCLUSIONS
  Off-pump Tector technique appears to be safe, offering a complete arterial revascularization and showing a reduction of surgical morbidity.
authors.affiliation: Servicio de Cirugía Cardíaca, Hospital Juan Canalejo, A Coruña.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cuenca
authors.forename: J M
authors.initials: JM
authors.lastname: Herrera
authors.forename: M A
authors.initials: MA
authors.lastname: Rodríguez-Delgadillo
authors.forename: G
authors.initials: G
authors.lastname: Paladini
authors.forename: V
authors.initials: V
authors.lastname: Campos
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez
authors.forename: J V
authors.initials: JV
authors.lastname: Valle
authors.forename: F
authors.initials: F
authors.lastname: Portela
authors.forename: F
authors.initials: F
authors.lastname: Crespo
authors.forename: A
authors.initials: A
authors.lastname: Juffé
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology