title: Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation.
abstract: OBJECTIVE
  To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization.
  
  
  METHODS
  Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors.
  
  
  RESULTS
  There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 +/- 7 vs 40 +/- 6 min, respectively), intensive care unit stay (mean, 25 +/- 8 vs 24 +/- 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 +/- 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P =.007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P =.0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P =.006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2.
  
  
  CONCLUSIONS
  Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.
authors.affiliation: Department of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Muneretto
authors.forename: Alberto
authors.initials: A
authors.lastname: Negri
authors.forename: Jacopo
authors.initials: J
authors.lastname: Manfredi
authors.forename: Alberto
authors.initials: A
authors.lastname: Terrini
authors.forename: Giulia
authors.initials: G
authors.lastname: Rodella
authors.forename: Suad
authors.initials: S
authors.lastname: Elqarra
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Bisleri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000637:transplantation*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate