Four or More Anastomoses – Total Arterial Complete Revascularization- Safe Arteries Maximization

Background: Despite accumulating evidence of prolonged survival and decreased cardiac events, the use of BITA and Radial artery still has not been accepted readily, probably because of perceptions of technical complexity, time constraints for conduit harvesting and increased peri-operative complications. We present our experience using these techniques on a routine basis.

Methods: A retrospective cohort of consecutive isolated coronary artery bypasses grafting surgeries (CABG) that received complete total arterial revascularization without the use of t-graft configuration, between March 2006 and February 2015

The primary outcomes were early complications: mortality, MACCE and sternal wound infection.

Results: Between March 2006 and February 2015, 430 patients (aged 59±9 years, 8% female) underwent Total arterial complete revascularization CABG. 91 patients (21%) had significant left main disease.144 (33.5%) had moderate to severe left ventricular dysfunction.

The incidence of diabetes mellitus was 189(43%), 87 (18%) insulin dependent. Mean BMI was 28.3±3.89 (31% had BMI>30) and mean Euroscore was 4.1%. 4 to 6 (mean 4.1±0.45) anastomoses were performed per patient.

Either both internal thoracic arteries (BITAs) (100%) or BITA and radial artery (95%) were used as conduits.

The rate of perioperative myocardial infarction was 0.2%. Sternal complications occurred in 1.16 % (1sternoplasty, 5 VAC, NO mortality). Perioperative 30 days mortality was 0.23% and 2.57% after 3 months.

Conclusions: Complete arterial revascularization in Multivessel CAD is feasible by using BITA and Radial artery with excellent perioperative results. Although BITA grafting is associated with a higher risk of DSWI, the considerable mortality from DSWI minimally affected overall survival. This approach allows for total arterial complete revascularization on a routine basis.