4 . 2018

Multiple coronary artery bypass surgery using two internal thoracic arteries

Abstract

Background. The use of the internal thoracic artery (ITA) for shunting the anterior descending artery has become the gold standard of coronary surgery. However, at present, the proportion of operations using two ITAs does not exceed 10% of the total number of coronary artery bypass surgery (CABG) operations.Aim of study – define the basic principles of technical execution of multiple CABG using two ITAs and to assess the safety of this operation.

Methods. Total number of 894 patients (2007–2017) underwent bilateral mammary artery coronary bypass grafting. Mean age of the patients was 58.5±8.5 (36–81), there were 754 (84.4%) male patients. ECG Q and QS waves were detected in 46.3% cases, mean LVEF was 42.6±8.1%.

Results. The interventions were performed with cardiopulmonary bypass and pharmacological cardioplegia in 212 (23.7%) patients, on-pump beating heart – in 293 (32.8%) and off-pump – in 389 (43.5%) cases. In most of the cases 68.6% both ITA were used as in situ grafts and only in 31.4% of cases a composite mammary artery bypass using a T-graft was performed. Revascularization index was 3.03±0.95. And autoarterial revascularization index using both ITA was 2.46±0.59. In 55.9% cases additionally we used autovenous graft, in 38 (5.2%) – radial artery graft. The number of autovenous grafts was higher 76.6% vs 23.3% cases when ITA in situ were used. Sequential bypass with mammary artery was performed in 39.4% patients. In-hospital mortality and perioperative MI rate was 0%. CHF requiring dopamine >5 mcg/kg/min was observed in 6% of patients, there was no case of IABP, resternotomy for bleeding was performed in 2.1% of cases.

Conclusion. Bilateral mammary artery multiple coronary bypass grafting is a modern and safe method of myocardial revascularization. It does not increase the risk of perioperative complications and should be considered as the method of choice in the majority of patients with ischemic heart disease, undergoing surgical treatment.

Keywords:coronary heart disease, two internal mammary arteries, surgery on beating heart

Clin Experiment Surg. Petrovsky J. 2018; 6 (4): 66–74.

doi: 10.24411/2308-1198-2018-14010. Received: 15.10.2018. Accepted: 24.10.2018.

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