Total arterial coronary revascularization
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2013-01-01
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Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery
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European Association of Cardiothoracic Surgery (EACTS Publishing Ltd)
Melbourne Authors
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Melbourne Medical School
Medicine (RMH Academic Centre)
Surgery (RMH)
Medicine (RMH Academic Centre)
Surgery (RMH)
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Journal Article
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Tatoulis, J. (2013). Total arterial coronary revascularization. Multimedia Manual of Cardiothoracic Surgery Mmcts European Association for Cardio Thoracic Surgery, 2013 (0), pp.mmt017-. https://doi.org/10.1093/mmcts/mmt017.
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Abstract
Arterial coronary grafts can be used in the majority of patients and have better patencies than saphenous vein grafts (SVGs), resulting in excellent perioperative and superior long-term outcomes. Barriers to their extensive use include potential for trauma and spasm, extra-operating time, unfamiliarity, concerns over hypoperfusion and deep sternal wound infection in patients in whom bilateral internal thoracic arteries are used-especially diabetics. This presentation addresses these concerns with particular attention to the radial artery, and skeletonized right internal thoracic artery harvest and construction of the proximal anastomoses of these grafts to the ascending thoracic aorta. The facile handling of these grafts and techniques identical to SVG grafting are emphasized. Avoidance of competitive flow and the importance of spasm prophylaxis cannot be overstated. Arterial grafts have patencies >90% at 10 years (SVG 50-60% at 10 years) and once functioning normally, remain free of atheroma. Long-term results are excellent, especially freedom from recurrent cardiac events and reoperations, even in patients with significant preoperative comorbidities such as diabetes and renal dysfunction. Depending on age, long-term survival is between 85 and 90% at 10 years and 75 and 80% at 15 years, and is always better than for one arterial graft plus SVG in all long-term risk-adjusted or propensity-matched studies.