Myocardial Revascularization with Arterial Conduits: Combined Use of Radial and Internal Mammary Arteries

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Abstract

Background

At present there is a renewed interest in the use of the radial artery in combination with other arterial conduits as an alternative for myocardial re-vascularization procedures.Material and methodWe show the results of 123 patients with a myocardial revascularization procedures performed by the same surgeon, using the radial artery as a conduit to revascularize preferably the circumflex and/or the right coronary arteries, combined with a left internal mammary artery graft to the left anterior descending artery and in some case a right internal mammary graft to the right coronary artery: these 123 patients were revascularized from May 1995to October 1996, using the radial artery as a free graft in Y or in T from the left internal mammary artery; mean age was62.11years, SD 10.56(range37-84years). Four hundred thirty seven graft were performed (mean3.56%per patient), of these 224, were with a radial artery, in all cases diltiazem was routinely administrated to prevent radial artery spasm. Forty four patients had coronary angiography before discharge.

Results

In-hospital: 1 patient(0.8%)died of a non-cardiac cause (sepsis) and 2patients (1.62%) had a perioperative myocardial infarction. The coronary angiography at discharge showed patent arterial conduits in all cases, although 3 (1.75%) had evidence of spasm. During follow-up (mean 9.2 months) 2 patients (1.6%) died of a massive gastrointestinal bleed, and the other of pneumonia, _no other events, nor interventions were registered, 92.68% of the patients were free of symptoms by the end of the follow-up.

Conclusions

1) In this series of patients control coronary angiography showed an optimal patency for all arterial conduits used. 2)A myocardial revascularization procedures only with arterial conduits is possible in the majority of patients, with the combined use of radial artery, left internal mammary artery and right internal mammary artery.