Impact of isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery in high-risk patients with three-vessel coronary artery disease.
BACKGROUND
Multiple strategies to achieve some degree of myocardial revascularization are available. In some, less complete revascularization is accepted to limit invasiveness, mostly in older, high-risk patients and patients with unsuitable coronary anatomy.


METHODS
Patient and operative data were collected retrospectively for all patients with three-vessel coronary artery disease who had off-pump coronary artery bypass surgery from January 2003 through December 2005. In-hospital outcomes, preoperative risk, survival and postoperative complications were compared between patients with complete (n = 89) and incomplete (n = 61) revascularization.


RESULTS
The mean follow-up was 20.2 +/- 4.6 months. Patients with incomplete revascularization tended to be older (76.8 +/- 1.4 years) than those with complete revascularization (66.3 +/- 1.0 years) and were more likely to have diabetes (43% versus 30%), cerebrovascular disease (18% versus 11%) and peripheral arterial disease (20% versus 9%), poorer ejection fraction (34.7 +/- 1.7% versus 50.8 +/- 1.5%) and greater EuroSCORE risk (9.7 +/- 2.1 vs. 5.1 +/- 1.3). In-hospital (3.3% versus 3.4%) and 6-month (4.9% versus 5.6%) mortality were not statistically different in the two groups, nor was recurrence of angina (3.3% versus 1.1%) or need for repeat revascularization (percutaneous or surgical) (4.9% versus 3.3%).


CONCLUSIONS
In high-risk patients with three-vessel coronary artery disease, the potential benefits of less invasive surgery should be considered. Surgical outcomes depend on preoperative condition rather than incomplete revascularization. Medium-term mortality and cardiac-related events associated with this surgical strategy are not increased.
Guerra
Miguel
M
Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal. migueldavidguerra@yahoo.com
Miranda
José António
JA
Ponce
Paulo
P
Mota
João Carlos
JC
Vouga
Luís
L
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors