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J Thorac Cardiovasc Surg 2003;125:826-835
© 2003 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Department of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.
Received for publication June 4, 2002. Revisions requested July 22, 2002; revisions received Aug 7, 2002. Accepted for publication Aug 16, 2002. Address for reprints: Claudio Muneretto, MD, UDA Cardiochirurgia—Spedali Civili, P.le Spedali Civili, 1 25123 Brescia, Italy (E-mail: munerett{at}master.cci.unibs.it).
Objectives: To evaluate the results of total arterial revascularization with composite grafts compared with the results of conventional coronary surgery, we enrolled 200 consecutive patient undergoing myocardial revascularization.
Methods: Patients were randomly assigned to 2 groups of 100 patients each: group 1 underwent total arterial revascularization, and group 2 received left internal thoracic artery on left anterior descending artery grafts plus additional saphenous vein grafts. The groups were comparable in terms of continuous and discrete variables and preoperative risk factors.
Results: There were no differences between group 1 and group 2 in terms of the number of grafted vessels (mean, 2.8 vs 2.9, respectively), crossclamping time (mean, 38 ± 7 vs 40 ± 6 min, respectively), intensive care unit stay (mean, 25 ± 8 vs 24 ± 7 hours, respectively), and hospital mortality (1% in both groups) nor were there any differences in postoperative complications. At the mean follow-up of 12 ± 4 months, patients receiving total arterial revascularization (group 1) showed a better outcome in terms of angina recurrence (group 1 vs group 2: 2 vs 13 patients, P = .007), need of percutaneous transluminal coronary angioplasty reintervention (group 1 vs group 2: 0 vs 8 patients, P = .0012), and actuarial freedom from cardiac events (group 1 vs group 2: 96% vs 67%, P = .006). Angiography carried out in 72% in group 1 and in 68% in group 2 demonstrated a patency rate of 99% of saphenous vein grafts in group 1 and 89% of saphenous grafts in group 2.
Conclusions: Total myocardial revascularization with composite arterial grafts provided superior clinical results and improved patient outcome, even in the short term to midterm. Arterial conduit-related benefits were clearly evident with respect to recurrence of angina and a higher graft patency rate.
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