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10.2 Experience with 500 bilateral internal thoracic artery operations
1400-1700
Tuesday, September 23, 1997
Session IO-CABG
II
Co-Chairmen:J.C. Schoevaerdts,A.J. Adn%pura Mountbatton Room 10.1 Complete Arterial Myocardial Three in Situ Arterial Grafts
Revascularization
With
H. NISHIDA, T. MAEDA, K. UWABE, k: TOMIZAWA, M. END0 and H. KOYANAGI, Tokyo, Japan From July 1989 to November 1996, 115 patients underwent coronary artery bypass grafting with three in situ arterial grafts; left and right internal thoracic arteries (LITA, RITA) and right gastroepiploic artery (RGEA). The patients who received additional saphenous vein grafts or free arterial grafts were excluded from this study. There were 107 male and eight female patients, with a mean age of 57.1 years (range 35-74 years). Postoperative follow-up ranged from 1 to 88 months with a mean of 29 months. One hundred and nine patients (95%) had either triple vessel disease or left main disease. The left ventricular ejection fraction was 40% or less in 24 patients (21%). Twenty-five patients underwent sequential arterial grafting (LITA: 14; RGEA: 11), and the mean number of distal anastomoses was 3.2. Although four patients (3.5%) developed perioperative myocardial infarction, there were no operative deaths or hospital deaths. Postoperative angiography was performed in 113 patients (98%). Graft patency rate was 97.6% (122/125) in the LITA, 100% (113/113) in the RITA and 96.8% (120/124) in the RGEA. Five patients (4.3%) died during follow-up period but four were noncardiac deaths. There were 11 postoperative percutaneous transluminal coronary angioplasties (PTCA) (lo%), but no patients required reoperations. Two patients (1.7%) developed myocardial infarction (MI). The S-year actuarial survival rate, cardiac-death free rate and cardiac event (cardiac death, MI, PTCA and reoperations) free rate was 90.1%, 96.9% and 88.6%, respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with only three in situ arterial grafts was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.
10.2 Experience with 500 Bilateral Internal Thoracic Artery Operations
J. W. IONES, S. SCHMIDT and A.C. BEALL, Houston, Texas, USA
Jr,
Multiple internal thoracic artery grafting (ITA) was met with early enthusiasm by the surgical profession, but skaepticism and controversy arose with reports of increased operative morbidity, insufficient graft blood flow, a high incidence of failure of the right ITA, and uncertain long-term benefits. To assess the actual incidence and impact of these complications
CARDIOVASCULAR SURGERY
SEPTEMBER 1997
and long-term results, we studied 500 consecutive patients with multiple ITA bypasses, constituting the experience of one surgeon performed over an 11 year period. Eighty-three percent of the patients were male with an average age of 59.6 years. The operative results did not support the claim that the procedure produces higher than acceptable mortality and morbidity rates. Operative mortality in the series was 1.6%, perioperative MI rate was 0.6%, and deep sternal wound infection occurred in 1.0%; 1.2% had strokes, and nine patients (1.8%) were returned to the OR for bleeding. One hundred and ninety-eight patients who had abnormal stress tests preoperatively had stress testing within 3 months of operation; 90.1% of these were normal, 3% were nondiagnostic, and 6.5% were abnormal but none required reoperation. After a mean follow-up of 6.6 years, (mode 7.2 years), 87.5% are alive and 93.2% of these have continuing good clinical results (NYHA class I or II). Eighty-nine patients were angiogrammed, with 90.8% parency rates of ITA bypasses and 84.5% patency of vein grafts. Only two patients from the entire series had repeat operations. Multiple ITA bypasses can be performed without excessive morbidity, with low reoperation rates and long-term outcomes that suggest reassessment of the procedure’s value is in order.
10.3 Effects of ITA Preparation Techniques on Postoperative Pain, Lung Function and Blood Loss
G. WIMMER-GREINECKER, M. YOSSEEF-HAKIMI, G. MATHEIS, R. BUHL, S. MARTENS, T. RlNNE and A. MORITZ, Frankfurt, Germany Respiratory distress is listed among the most frequent complications after aortocoronary bypass grafting (CABG). A prospective randomized clinical study was conducted to examine postoperative pain, lung function and blood loss considering two different techniques of TTA preparation in 3 16 patients. In group A (n = 59) the ITA was dissected with the complete surrounding connective tissue after opening of the pleura; lateral pleural drainage was performed routinely. In group B (n = 57) a venoarterial pedicle without muscular support and without primary opening of the pleura was strived. Six days postoperatively, clinical outcome, lung function. location and intensity of pain were compared to preoperative data. Further examinations will conducted after 3 months and will be presented. Postoperative blood loss after 12 h was significantly higher in group A (A: 610 * 58 ml; B: 462 II: 46 ml; P = 0,025). Both groups showed a restriction in FEVUFVC ratio. which was
49
Tuesday, September 23, 1997
Session IO-CABG
II
Co-Chairmen:J.C. Schoevaerdts,A.J. Adn%pura Mountbatton Room 10.1 Complete Arterial Myocardial Three in Situ Arterial Grafts
Revascularization
With
H. NISHIDA, T. MAEDA, K. UWABE, k: TOMIZAWA, M. END0 and H. KOYANAGI, Tokyo, Japan From July 1989 to November 1996, 115 patients underwent coronary artery bypass grafting with three in situ arterial grafts; left and right internal thoracic arteries (LITA, RITA) and right gastroepiploic artery (RGEA). The patients who received additional saphenous vein grafts or free arterial grafts were excluded from this study. There were 107 male and eight female patients, with a mean age of 57.1 years (range 35-74 years). Postoperative follow-up ranged from 1 to 88 months with a mean of 29 months. One hundred and nine patients (95%) had either triple vessel disease or left main disease. The left ventricular ejection fraction was 40% or less in 24 patients (21%). Twenty-five patients underwent sequential arterial grafting (LITA: 14; RGEA: 11), and the mean number of distal anastomoses was 3.2. Although four patients (3.5%) developed perioperative myocardial infarction, there were no operative deaths or hospital deaths. Postoperative angiography was performed in 113 patients (98%). Graft patency rate was 97.6% (122/125) in the LITA, 100% (113/113) in the RITA and 96.8% (120/124) in the RGEA. Five patients (4.3%) died during follow-up period but four were noncardiac deaths. There were 11 postoperative percutaneous transluminal coronary angioplasties (PTCA) (lo%), but no patients required reoperations. Two patients (1.7%) developed myocardial infarction (MI). The S-year actuarial survival rate, cardiac-death free rate and cardiac event (cardiac death, MI, PTCA and reoperations) free rate was 90.1%, 96.9% and 88.6%, respectively. In conclusion, the clinical outcome of the coronary artery bypass grafting with only three in situ arterial grafts was satisfactory in terms of low operative risk, high patency rate, and excellent long-term results.
10.2 Experience with 500 Bilateral Internal Thoracic Artery Operations
J. W. IONES, S. SCHMIDT and A.C. BEALL, Houston, Texas, USA
Jr,
Multiple internal thoracic artery grafting (ITA) was met with early enthusiasm by the surgical profession, but skaepticism and controversy arose with reports of increased operative morbidity, insufficient graft blood flow, a high incidence of failure of the right ITA, and uncertain long-term benefits. To assess the actual incidence and impact of these complications
CARDIOVASCULAR SURGERY
SEPTEMBER 1997
and long-term results, we studied 500 consecutive patients with multiple ITA bypasses, constituting the experience of one surgeon performed over an 11 year period. Eighty-three percent of the patients were male with an average age of 59.6 years. The operative results did not support the claim that the procedure produces higher than acceptable mortality and morbidity rates. Operative mortality in the series was 1.6%, perioperative MI rate was 0.6%, and deep sternal wound infection occurred in 1.0%; 1.2% had strokes, and nine patients (1.8%) were returned to the OR for bleeding. One hundred and ninety-eight patients who had abnormal stress tests preoperatively had stress testing within 3 months of operation; 90.1% of these were normal, 3% were nondiagnostic, and 6.5% were abnormal but none required reoperation. After a mean follow-up of 6.6 years, (mode 7.2 years), 87.5% are alive and 93.2% of these have continuing good clinical results (NYHA class I or II). Eighty-nine patients were angiogrammed, with 90.8% parency rates of ITA bypasses and 84.5% patency of vein grafts. Only two patients from the entire series had repeat operations. Multiple ITA bypasses can be performed without excessive morbidity, with low reoperation rates and long-term outcomes that suggest reassessment of the procedure’s value is in order.
10.3 Effects of ITA Preparation Techniques on Postoperative Pain, Lung Function and Blood Loss
G. WIMMER-GREINECKER, M. YOSSEEF-HAKIMI, G. MATHEIS, R. BUHL, S. MARTENS, T. RlNNE and A. MORITZ, Frankfurt, Germany Respiratory distress is listed among the most frequent complications after aortocoronary bypass grafting (CABG). A prospective randomized clinical study was conducted to examine postoperative pain, lung function and blood loss considering two different techniques of TTA preparation in 3 16 patients. In group A (n = 59) the ITA was dissected with the complete surrounding connective tissue after opening of the pleura; lateral pleural drainage was performed routinely. In group B (n = 57) a venoarterial pedicle without muscular support and without primary opening of the pleura was strived. Six days postoperatively, clinical outcome, lung function. location and intensity of pain were compared to preoperative data. Further examinations will conducted after 3 months and will be presented. Postoperative blood loss after 12 h was significantly higher in group A (A: 610 * 58 ml; B: 462 II: 46 ml; P = 0,025). Both groups showed a restriction in FEVUFVC ratio. which was
49