title: Total arterial revascularization and concomitant aortic valve replacement.
abstract: The safety of total arterial revascularization with a left internal thoracic artery-radial artery T-graft was evaluated in patients with at least two-vessel coronary artery disease and aortic valve stenosis requiring concomitant aortic valve replacement. From June 2001 to January 2005, 18 patients underwent aortic valve replacement and total arterial revascularization, while 101 had aortic valve replacement and conventional grafting. By matching age, sex, left ventricular ejection fraction, and number of distal anastomoses, 1:2 matched groups were generated: 15 patients with a left internal thoracic-radial artery T-graft, and 30 with left internal thoracic artery and additional vein grafts. Aortic cross clamp and cardiopulmonary bypass times were similar in both groups. There were no significant differences in postoperative data between the groups. Early mortality was 0% in the T-graft group and 2% in those with conventional grafts. Follow-up ranged from 2 to 50 months. Event-free survival was 100% in the T-graft group and 90% in the conventional graft group. Total arterial grafting with a left internal thoracic-radial artery T-graft can be performed in selected patients with aortic valve stenosis requiring simultaneous aortic valve replacement.
authors.affiliation: Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Shrestha.Malakh.Lal@mh-hannover.de
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.forename: Michael
authors.initials: M
authors.lastname: Maringka
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D003250:Constriction; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D013318:Stroke Volume; D013895:Thoracic Arteries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation*; D016277:Ventricular Function, Left