%0 Journal Article
%T Total arterial myocardial revascularization : Analysis of initial experience.
%A Raja Shahzad
%A Haider Zulfiqar
%A Zaman Haider
%A Ahmed Mukhtar
%J Annals of Saudi Medicine
%D 2005
%I King Faisal Specialist Hospital and Research Centre
%X BACKGROUND : Total arterial myocardial revascularization is an attempt to overcome the problems of late vein graft atherosclerosis, occlusion and need for coronary re-operations. Despite increasing evidence of efficacy, the use of arterial conduits has not been accepted as a primary practice in most of the centers in Pakistan for various reasons. We analyze our initial experience to assess the feasibility of total arterial revascularization as a primary strategy in patients requiring first time coronary artery bypass grafting. METHODS : Two hundred patients undergoing first time CABG at our institution, from January 2000 to April 2001, were studied. Group 1 consisted of 100 patients undergoing total arterial revascularization (using bilateral internal thoracic and radial arteries) and Group 2 consisted of 100 patients undergoing conventional CABG (using one internal thoracic artery and supplemental veins). Thirty-day mortality and early morbidity with particular reference to resternotomy for bleeding, cerebrovascular accidents, renal failure, and sternal dehiscence were the main outcome measures. RESULTS : Patients in Group 1 were younger (56.2¡À10.4 vs. 60.3¡À9.8 years; P < 0.001), had lower Parsonnet scores (4.8¡À0.4 vs. 9.6¡À1.8; P < 0.001), and had better left ventricular function. Both groups received a similar number of grafts. The percentage of patients undergoing total arterial revascularization rose from 20% in the first three months to over 65% in the three later three-month periods. Overall 30-day mortality was 1.5%, one patient (1%) in Group 1 and two patients (2%) in Group 2. There was a similar incidence of postoperative complications and length of median postoperative stay in both groups. CONCLUSION : Total arterial revascularization can be adopted as a primary strategy in most patients undergoing CABG with no increase in mortality or morbidity.
%U http://www.saudiannals.net/article.asp?issn=0256-4947;year=2005;volume=25;issue=1;spage=13;epage=17;aulast=Raja