Document Detail


Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts.
MedLine Citation:
PMID:  12611729     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Total arterial off-pump coronary artery bypass (OPCAB) grafting with only internal thoracic artery (ITA) and composite radial artery (RA) grafts has been applied extensively to avoid cerebral complications and late vein graft failure. We evaluated the initial experience with this method by clinical and angiographic study. METHODS: Between April 2000 and May 2002, 257 patients underwent OPCAB grafting with this technique. The range of ages at operation was 42 to 86 years (mean, 66.1 +/- 8.6 years). On average, 3.28 +/- 0.86 grafts per patient were completed. More than 4 distal anastomoses were performed in 88 patients (34%). For coronary revascularization, 289 ITA and 555 RA grafts were used. The RA was used as a Y graft in 211 patients, as an I graft (for ITA extension) in 52 patients, and as a K graft (the side of the RA attached to the side of the left ITA) in 28 patients. Sequential bypass grafting was performed with 190 RA and 7 ITA grafts. The sites of distal anastomoses were 256 left anterior descending arteries (30%), 236 posterolateral branches (28%), 144 posterior descending arteries (17%), 106 diagonal branches (13%), 82 obtuse marginal branches (10%), and 19 right coronary arteries (2%). RESULTS: There were 1 operative death (0.4%) due to cerebral hemorrhage and 2 episodes of stroke (0.8%) during postoperative angiography. There were no clinical underperfusion syndromes or new intra-aortic balloon pump insertions. Perioperative myocardial infarction occurred in 12 patients (4.7%), sternal dehiscence in 5 (1.9%), and early coronary intervention in 4 (1.6%). There was no deep wound infection, reexploration for bleeding, or hand ischemia. The actuarial survival rate and the cardiac event-free rate at 2 years were 98.6% +/- 2.4% and 94.2% +/- 0.8%, respectively. Early postoperative angiography revealed a 97.8% (264/270) graft patency of ITAs and 97.9% (512/523) graft patency of RAs in 238 patients. Flow competition of the RA graft was recognized in 22 patients and, as indicated by follow-up angiographic study, did not cause late graft occlusion. CONCLUSIONS: OPCAB grafting with ITAs and composite RAs provides excellent early and intermediate clinical results and graft patency.
Authors:
Junjiro Kobayashi; Osamu Tagusari; Ko Bando; Kazuo Niwaya; Hiroyuki Nakajima; Michiko Ishida; Satsuki Fukushima; Soichiro Kitamura
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The heart surgery forum     Volume:  6     ISSN:  1522-6662     ISO Abbreviation:  Heart Surg Forum     Publication Date:  2002  
Date Detail:
Created Date:  2003-03-03     Completed Date:  2003-04-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100891112     Medline TA:  Heart Surg Forum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  30-7     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. jkobayas@hsp.ncvc.go.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Coronary Angiography
Coronary Artery Bypass / methods*,  mortality
Humans
Internal Mammary-Coronary Artery Anastomosis / methods
Middle Aged
Myocardial Infarction / surgery
Postoperative Complications / mortality
Radial Artery / transplantation*
Vascular Patency

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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