[Complete arterial revascularization of multivessel coronary disease: are conduits sufficient?].
BACKGROUND
Complete arterial coronary artery bypass grafting seems to be an alternative surgical approach in the treatment of coronary artery disease. Complications in the long-term follow-up due to degeneration of venous grafts may be reduced using arterial conduits. Prolonged operating times and increased trauma due to harvesting of multiple arterial grafts have been arguments for the conventional operative approach. We present our experience using new operative techniques, such as skeletonization of arterial grafts and the T-graft configuration.


METHODS
Between 3/96 and 7/99, 405 patients with multiple coronary artery disease underwent complete arterial revascularization at our institution. The operations were performed using only two skeletonized grafts, both internal thoracic arteries in 105 patients (25.9%), internal thoracic artery and radial artery in 299 patients (73.8%) and 1 radial artery in 1 patient (0.3%).


RESULTS
In 346 patients (85.4%) a T-graft configuration was used. A mean of 4.1 +/- 0.9 coronary anastomoses were performed per patient. In hospital mortality was 2%. Sternal dehiscence or infection occurred in 0.8% of patients. Harvesting of the radial artery was performable with a low morbidity. One week postoperatively, coronary angiography showed 96.7% of coronary anastomoses free of stenosis > 50%.


CONCLUSIONS
Complete arterial coronary revascularization using skeletonized grafts and the T-graft approach is a safe technique in the treatment of multiple coronary artery disease. Low perioperative morbidity and mortality make its usage on a routine basis possible.
Wendler
O
O
Klinik für Thorax- und Herz-Gefässchirurgie Universitätskliniken des Saarlandes, Homburg/Saar. chowen@med.rz.uni-sb.de
Hennen
B
B
Markwirth
T
T
Graeter
T
T
Tscholl
D
D
Schäfers
H J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017534:Radial Artery / Q000637:transplantation; D013895:Thoracic Arteries / Q000637:transplantation; D013997:Time Factors