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J Thorac Cardiovasc Surg 2008;135:1069-1075
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

Sune Damgaard, MDa,*, Jens T. Lund, MDa, Nikolaj B. Lilleør, RNa, Mario J. Perko, MD, DMSca, Kåre Sander, MD, DMSca, Blagoja Dimo, MDa, Maiken B. Jensen, MDb, Jan K. Madsen, MD, DMScd, Henning Kelbæk, MD, DMScc, Daniel A. Steinbrüchel, MD, DMSca

a Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
b Department of Cardiothoracic Anesthesia, Rigshospitalet, Copenhagen University Hospital, Denmark
c Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
d Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark

Received for publication May 16, 2007; revisions received September 25, 2007; accepted for publication October 5, 2007.

* Address for reprints: Sune Damgaard, MD, Department of Cardiothoracic Surgery RT 2152, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. (Email: sunedamgaard{at}dadlnet.dk).

Objective: The in-hospital safety of total arterial revascularization for coronary artery bypass surgery seems to be comparable to conventional revascularization, but randomized trials evaluating this are few and data on complications in the postoperative months are sparse.

Methods: In a randomized single-center trial, 331 patients underwent total arterial revascularization using single or bilateral internal thoracic and radial arteries versus conventional revascularization using the left internal thoracic artery and saphenous vein grafts. We report the results from 3 months' follow-up.

Results: The mean age of patients was 59 ± 8 years, and 39 were women (12%). The median EuroSCORE was 2 (interquartile range 1–4). The arterial group comprised 161 patients, and the conventional group comprised 170 patients. The mean number of bypasses in the arterial group was 2.9 ± 0.9 versus 3.2 ± 0.9 in the conventional group (P = .004). Three months' follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound complications requiring hospitalization: 3 (1.9%) versus 6 (3.5%) (P = .50), respectively.

Conclusion: These results confirm previous reports that total arterial revascularization can be performed with low in-hospital morbidity and mortality. Further, in the 3 postoperative months, total arterial revascularization did not lead to more complications or admissions than conventional surgery. Arterial grafting was performed with significantly fewer bypasses, but no differences in anginal status were seen after 3 months. A tendency toward more sternal complications after arterial grafting was observed, but clinical outcomes were comparable to conventional grafting.

Abbreviations and Acronyms BITA = bilateral internal thoracic artery; CABG = coronary artery bypass grafting; ITA = internal thoracic artery; LAD = left anterior descending; LITA = left internal thoracic artery; PCI = percutaneous coronary intervention; RITA = right internal thoracic artery; TAR = total arterial revascularization




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