PMID- 16550306
OWN - NLM
STAT- MEDLINE
DCOM- 20070515
LR  - 20181113
IS  - 0910-8327 (Print)
IS  - 0910-8327 (Linking)
VI  - 21
IP  - 2
DP  - 2006 Mar
TI  - Perioperative and clinical-angiographic late outcome of total arterial myocardial 
      revascularization according to different composite original graft techniques.
PG  - 69-77
AB  - Total arterial myocardial revascularization (TAMR) is advisable because of the 
      excellent long-term patency of arterial conduits. We present early and midterm 
      outcomes of five different surgical configurations for TAMR. Between January 1998 
      and May 2004, 112 patients (aged 56.5 +/- 4.5 years, 20% female) with 
      three-vessel disease underwent TAMR. The internal mammary arteries (IMAs) were 
      harvested in a sketelonized fashion. The surgical techniques for TAMR consisted 
      in Y or T composite grafts (n = 88, 78%) constructed between the in situ right 
      IMA (RIMA) and the free left IMA (LIMA) graft (n = 58) or the radial artery (n = 
      30) (RA) in three different configurations. The other techniques consisted in T- 
      and inverted T-graft (n = 24, 22%) constructed between the RA conduit and the 
      free LIMA graft in two different configurations. The mean follow-up time was 40 
      +/- 23 months. Postoperative angiographic control was performed in 76/111 (70%) 
      patients. Overall, 472 arterial anastomoses (average 4.2 per patient) were 
      performed. One (0.9%) patient, undergoing the inverted T-graft technique, died on 
      postoperative day 2. Another patient (0.9%), undergoing the lambda-graft 
      technique using both IMAs and RA, suffered a new myocardial infarction probably 
      due to RA conduit vasospasm. One week after surgery, after the transthoracic 
      echocardiographic Doppler with adenosine provocative test, the coronary flow 
      reserve (CFR) at the LIMA and RIMA main stems were 2 +/- 0.4 and 2.4 +/- 0.3, 
      respectively. At 12-month follow-up, after adenosine provocative test, the CFRs 
      at the LIMA and RIMA stems were significantly higher than the values at 1 week 
      after surgery within the same group; (LIMA)CFR (1 week) 2.4 +/- 0.3 (12 months) 
      vs 2 +/- 04 (1 week), P = 0.002; (RIMA)CFR 2.58 +/- 0.4 vs 2.4 +/- 0.3, P = 
      0.001. The CFR at the RIMA main stem was higher in all measurements within the 
      same group than in the LIMA main stem, but not significantly. In one patient 
      undergoing the lambda-graft technique using both IMAs, the RIMA was found to have 
      a string sign. Postoperative angiography in 50 patients showed that the patency 
      rate for the LIMA was 100%, for the RIMA 97.3%, and for the RA 96.7%. Angiography 
      at 3-year follow-up in 76 patients documented excellent patency rates of the LIMA 
      (97.4%), RIMA (95%), and RA (87%). Survival at 7 years was 92.5%, event-free 
      survival 89.3%, and freedom from angina 94%. Total arterial myocardial 
      revascularization using different surgical configurations is safe and effective. 
      The use of composite arterial grafts provides excellent clinical and angiographic 
      results, with a low rate of angina recurrence and late cardiac events. These 
      configurations allow for complete arterial revascularization.
FAU - Bonacchi, Massimo
AU  - Bonacchi M
AD  - Cattedra e Scuola di Specializzazione in Cardiochirurgia, University Hospital of 
      Florence Careggi, Florence, Italy. mbonacchi@unifi.it
FAU - Prifti, Edvin
AU  - Prifti E
FAU - Maiani, Massimo
AU  - Maiani M
FAU - Frati, Giacomo
AU  - Frati G
FAU - Giunti, Gabriele
AU  - Giunti G
FAU - Di Eusanio, Marco
AU  - Di Eusanio M
FAU - Di Eusanio, Giuseppe
AU  - Di Eusanio G
FAU - Leacche, Marzia
AU  - Leacche M
LA  - eng
PT  - Journal Article
PL  - Japan
TA  - Heart Vessels
JT  - Heart and vessels
JID - 8511258
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Flow Velocity
MH  - Cardiopulmonary Bypass
MH  - Coronary Angiography
MH  - Coronary Disease/diagnosis/*surgery
MH  - Echocardiography, Doppler
MH  - Female
MH  - Graft Occlusion, Vascular
MH  - Humans
MH  - Internal Mammary-Coronary Artery Anastomosis
MH  - Male
MH  - Middle Aged
MH  - Myocardial Revascularization/*methods
MH  - Postoperative Complications
MH  - Radial Artery/transplantation
MH  - Statistics, Nonparametric
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Vascular Patency
EDAT- 2006/03/22 09:00
MHDA- 2007/05/16 09:00
CRDT- 2006/03/22 09:00
PHST- 2005/01/18 00:00 [received]
PHST- 2005/07/23 00:00 [accepted]
PHST- 2006/03/22 09:00 [pubmed]
PHST- 2007/05/16 09:00 [medline]
PHST- 2006/03/22 09:00 [entrez]
AID - 10.1007/s00380-005-0856-2 [doi]
PST - ppublish
SO  - Heart Vessels. 2006 Mar;21(2):69-77. doi: 10.1007/s00380-005-0856-2.