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J Thorac Cardiovasc Surg 1997;114:911-916
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

TOTAL MYOCARDIAL REVASCULARIZATION WITH ARTERIAL CONDUITS: RADIAL ARTERY COMBINED WITH INTERNAL THORACIC ARTERIES

Ernesto E. Weinschelbaum , MDa, Eduardo D. Gabe , MDb, Alejandro Macchia , MDb, Raffaele Smimmo , MDa, Luis D. Suárez , MDc

Received for publication Feb. 6, 1997 Revisions requested March 11, 1997 Revisions received June 16, 1997 Accepted for publication July 21, 1997 Address for reprints: Ernesto Eduardo Weinschelbaum, MD, Department of Cardiovascular Surgery, Favaloro Foundation, Belgrano 1746, 1093 Buenos Aires, Argentina.

Abstract

Objective: We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery. Methods: In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 ± 1 [standard deviation] per patient), 296 (1.8 ± 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 ± 6.1) months. Results: Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms. Conclusions: The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.




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