Surgical revascularization of coronary bifurcations employing a single arterial graft according to the "omega-anastomosis" technique: initial experience.
OBJECTIVE
The aim of this study was to evaluate the early postoperative outcome in patients undergoing "omega-anastomosis" construction, a technique that permits revascularization of coronary bifurcations employing a single arterial graft.


METHODS
Between January 2000 and March 2002, omega-anastomosis was employed in 12 patients. The main indication for omega-anastomosis construction was the presence of a significant stenotic lesion involving one of the coronary tree's bifurcations, presenting a relevant secondary branch. There were ten men and two women, with a mean age of 55.4 +/- 4.3 years (range 48 to 66). The omega-anastomosis was constructed employing a single arterial graft (internal mammary artery or radial artery) effectively tailored to obtain a bi-petal shape and anastomosed to the coronary bifurcation according to a three-foliate anastomosis. All patients underwent postoperative coronary angiography.


RESULTS
There were no hospital deaths, neither ECG nor enzymatic alterations. One patient was reoperated for excessive bleeding. The mean aortic cross-clamp time and duration of CPB (cardiopulmonary bypass) were 64 +/- 18 minutes (range 45 to 108) and 89 +/- 26 minutes (range 67 to 135), respectively. Thirty-four arterial conduits were used: 12 LIMA, 12 RIMA, and 10 RA. Twelve omega-anastomoses were constructed, in six patients employing the RA, and in six other patients employing one of the internal mammary arteries (IMAs). Five left Y-grafts between the in situ LIMA and free LIMA graft and one right Y-graft between the RIMA and RA were constructed. The mean ICU stay was 14.4 +/- 5.7 hours. The postoperative coronary angiography revealed a good patency of the "omega-anastomosis." Transthoracic color Doppler echocardiography (TTECD) demonstrated a normal IMAs flow pattern in all cases.


CONCLUSIONS
We define the reported configuration as a possible surgical alternative to achieve total arterial myocardial revascularization in multi-vessels patients, associated with excellent postoperative outcome that should be part of the coronary surgical armamentarium.
Bonacchi
Massimo
M
Department of Cardiac Surgery, University of Florence, Florence, Italy. mbonacchi@unifi.it
Battaglia
Francesco
F
Prifti
Edvin
E
Giunti
Gabriele
G
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000601:surgery; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000637:transplantation*; D016896:Treatment Outcome