Long-term follow-up of total arterial revascularization with left internal thoracic artery and radial artery T-grafts: survival, cardiac morbidity and quality of life.

Abstract

Coronary artery bypass grafting is the gold standard for the treatment of patients with multiple-vessel coronary artery disease. The long-term outcome can be improved using arterial grafts. We analysed the initial series of patients who underwent total arterial revascularization at our institute using left internal thoracic artery (LITA) and radial artery (RA) composite T-grafts and had a follow-up of >10 years. We included all patients who received an isolated, non-emergent total arterial revascularization using LITA-RA T-grafts between September 1996 and August 2001 in our institution. We performed a follow-up of 138 patients (104 male, 60 ± 9 years old). Early outcome was excellent. The 30-day mortality, reoperation, neurological complication and myocardial ischaemia rate was 1% (n = 2), 5% (n = 7), 2% (n = 3) and 2% (n = 3), respectively. Mean follow-up was 11 ± 3 years. Long-term survival was 79% (n = 86). There were seven cardiac deaths during follow-up. Freedom from major cardiovascular events for 1, 5 and 10 years was 97, 91 and 84%, respectively. A total of 95 coronary angiographies were performed 4.6 ± 4.1 years postoperatively. In total, 453 anastomoses using the composite graft (LITA-RA as T-graft) were performed. During follow-up, 35 anastomoses were occluded (30 RA anastomoses and 5 LITA anastomoses), leading to an occlusion rate of 7.7% during follow-up. Percutaneous coronary intervention was performed in 18 cases and coronary reoperation in two cases during follow-up. Quality-of-life assessment by Minnesota Living with Heart Failure Questionnaire revealed excellent results. Total arterial revascularization using composite LITA-RA T-grafts leads to excellent long-term results after >10 years.