Bilateral Internal Thoracic Artery T-grafting with and without Cardiopulmonary Bypass

Stanislav Tsygelnikov, Ivan Pets, Andrey Lebedev, Viktor Pshenichnykh, Tatyana Polyakova, Sergey Kurnosov

GKB V.V.Veresaeva, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objectives: To share our experience of bilateral internal thoracic artery T-grafting with and without cardiopulmonary bypass (CPB).

Methods: T-grafting was performed in 208 patients (131 male, 77 female), with 53 cases without CPB (group A) and 155 cases with CPB (group B). The mean age in group A was 69.5 yrs, with 66% aged >70 yrs, and in group B – 59.5 yrs, with 31% aged >70 yrs. Coronary angiography showed left main coronary artery involvement in 57%, group A, vs. 39%, group B. Peripheral artery disease was diagnosed in 64%, group A, vs. 32%, group B. Chronic renal disease was found in 11%, group A, vs. 4%, group B. There were patients with diabetes mellitus in both groups: 37%, group A (insulin therapy in 9%), vs. 46%, group B (insulin therapy in 22%). Obesity was diagnosed in 26%, group A, vs. 20%, group B. There was no significant difference in chronic pulmonary disease (15% vs. 12%) and old myocardial infarction (32% vs. 33%) in both groups.

Results: Two to four grafts were used in group A (vein grafts in 27%), two to six grafts – in group B (vein grafts in 67%). Total arterial coronary revascularization was performed in 73.5%, group A, vs. 32.9%, group B. Sequential anastamoses in group A were LITA - 15%, RITA - 25%; in group B – LITA – 17%, RITA – 13%. The major complications were graft failure (group B, 1.2%), bleeding (group B, 0.6%), mediastinitis (group A, 1.8% vs. group B, 0.6%), wound infection (group A, 1.8% vs. group B, 1.2%). There were five deaths (3%) in group B: acute heart failure - 1.8%, multiple organ dysfunction syndrome (0.6%), pulmonary embolism (0.6%).

Conclusion: Bilateral internal thoracic artery T-grafting with and without CPB allows to achieve satisfactory revascularization in patients with severe comorbidities without the in-hospital risk increase.