Total arterial myocardial revascularization: analysis of initial experience.

BACKGROUND Total arterial myocardial revascularization is an attempt to overcome the problems of late vein graft atherosclerosis, occlusion and need for coronary re-operations. Despite increasing evidence of efficacy, the use of arterial conduits has not been accepted as a primary practice in most of the centers in Pakistan for various reasons. We analyze our initial experience to assess the feasibility of total arterial revascularization as a primary strategy in patients requiring first time coronary artery bypass grafting. METHODS Two hundred patients undergoing first time CABG at our institution, from January 2000 to April 2001, were studied. Group 1 consisted of 100 patients undergoing total arterial revascularization (using bilateral internal thoracic and radial arteries) and Group 2 consisted of 100 patients undergoing conventional CABG (using one internal thoracic artery and supplemental veins). Thirty-day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. RESULTS Patients in Group 1 were younger (56.2 +/- 10.4 vs. 60.3 +/- 9.8 years; P < 0.001), had lower Parsonnet scores (4.8 +/- 0.4 vs. 9.6 +/- 1.8; P < 0.001), and had better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularization rose from 20% in the first three months to over 65% in the three later three-month periods. Overall 30-day mortality was 1.5%, one patient (1%) in Group 1 and two patients (2%) in Group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. CONCLUSION Total arterial revascularization can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.