title: Long-term follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts: survival, cardiac morbidity and quality of life.
abstract: OBJECTIVE
  Coronary artery bypass grafting is the gold standard for the treatment of patients with multiple-vessel coronary artery disease. The long-term outcome can be improved using arterial grafts. We analysed the initial series of patients who underwent total arterial revascularization at our institute using left internal thoracic artery (LITA) and radial artery (RA) composite T-grafts and had a follow-up of >10 years.
  
  
  METHODS
  We included all patients who received an isolated, non-emergent total arterial revascularization using LITA-RA T-grafts between September 1996 and August 2001 in our institution. We performed a follow-up of 138 patients (104 male, 60 ± 9 years old).
  
  
  RESULTS
  Early outcome was excellent. The 30-day mortality, reoperation, neurological complication and myocardial ischaemia rate was 1% (n = 2), 5% (n = 7), 2% (n = 3) and 2% (n = 3), respectively. Mean follow-up was 11 ± 3 years. Long-term survival was 79% (n = 86). There were seven cardiac deaths during follow-up. Freedom from major cardiovascular events for 1, 5 and 10 years was 97, 91 and 84%, respectively. A total of 95 coronary angiographies were performed 4.6 ± 4.1 years postoperatively. In total, 453 anastomoses using the composite graft (LITA-RA as T-graft) were performed. During follow-up, 35 anastomoses were occluded (30 RA anastomoses and 5 LITA anastomoses), leading to an occlusion rate of 7.7% during follow-up. Percutaneous coronary intervention was performed in 18 cases and coronary reoperation in two cases during follow-up. Quality-of-life assessment by Minnesota Living with Heart Failure Questionnaire revealed excellent results.
  
  
  CONCLUSIONS
  Total arterial revascularization using composite LITA-RA T-grafts leads to excellent long-term results after >10 years.
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany fleissner.felix@mh-hannover.de.
authors.forename: Felix
authors.initials: F
authors.lastname: Fleissner
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Hendrick
authors.initials: H
authors.lastname: Engelke
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rojas-Hernandez
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Issam
authors.initials: I
authors.lastname: Ismail
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Penelope
authors.initials: P
authors.lastname: Stiefel
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Serghei
authors.initials: S
authors.lastname: Cebotari
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Clinic for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery / Q000637:transplantation*; D008875:Middle Aged; D017202:Myocardial Ischemia; D011183:Postoperative Complications; D011788:Quality of Life; D017534:Radial Artery / Q000601:surgery / Q000637:transplantation*; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Arterial graft; Coronary artery bypass graft; Myocardial ischaemia; Radial artery