Total Arterial Myocardial Revascularization
Basrah Journal of Surgery,
2003, Volume 9, Issue 1, Pages 51-55
AbstractEighty-five patients underwent myocardial revascularization using artery grafts alone and were followed up for 30 months. Twenty-seven patients (31.7%) had single vessel disease, 28 patients (32.94%) had two-vessel disease and 30 patients (35.3%) had three or more obstructed coronary arteries. Eight of the patients had undergone previous surgical revascularization. The left internal mammary artery (LIMA) was routinely used for the left anterior descending branch (LAD). In 8 patients (9.4%), the in situ right internal mammary artery (RIMA) was used for revascularization of the right coronary artery (RCA) and its branches. The RIMA was sometimes used as a free graft from the aorta or as an artificial “Y” from the LIMA to the diagonal and marginal branches. We used the left radial artery (RA) as arterial conduit in 51 patients (60%). There were 2 intraoperative deaths. Hospital mortality was 9% (n=8). Of the fatal cases, 3 were redo surgeries, 3 underwent combined procedures (one for left ventricular aneyrysm, one for double valve replacement and one for mitral valve replacement) while only 3 of the fatal cases underwent revascularization as a primary and isolated procedure. It is concluded that complete arterial reconstruction carries an acceptably low operative mortality and excellent short-term follow-up. This strategy is particularly important for young patients to reduce the probability of future reoperation.
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