Total arterial myocardial revascularization - strategy, early and midterm results

Total arterial myocardial revascularization (TAMR) represents a new alternative procedure to the classical aorto-coronary bypass operation with venous graft material. The early and midterm results with the use of the left and right internal thoracic artery (LITA and RITA) and radial artery (RA) for coronary artery bypass grafting are analyzed to assess the suitability of these conduits for myocardial revascularization. From June 1997 to June 2001, 234 patients suffering from a coronary artery disease underwent TAMR at our institution. The bypass material consisted of 234 LITAs, 160 RITAs and 84 RAs. The most frequently used conduit combination was a T-graft (n=213) consisting of a free arterial graft (RITA or RA) centrally implanted into LIMA "in situ" using an end-to-site grafting technique. The mean left ventricular ejection fraction was 0.59 +/- 0.4. In 150 patients (64.1%), the operation was performed on an urgent basis and in 24 cases (10.2%) it was a reoperation. A mean of 3.3 +/- 0.9 coronary anastomoses per patient was performed. The mean aortic cross-clamping time was 71 20 minutes. In 194 cases (83%), the postoperative course was uneventful. The early mortality was 0.8% (n=2). Complications included myocardial infarction in 4 patients (1.7%), sternal infection in 2 (0.8%), renal insufficiency in 2 (0.8%), prolonged respiratory ventilation in 28 (11.9%) and reoperation for bleeding in 6 (2.5%). At a mean follow-up of 25 +/- 1.3 months 197 patients (96.6%) were asymptomatic. Late mortality was 3.3 % (n = 7). TAMR is a safe and reliable procedure with very good early and midterm results. The results reported in this study support the widened use of this coronary artery grafting strategy.