THE COMPARISON OF THE EARLY AND MIDTERM RESULTS OF THE PROXIMAL ANASTOMOSIS TECHNIQUES IN SEQUENTIAL RADIAL ARTERY GRAFTING

Esat Akıncı, Kemal Uzun, Vedat Erentuğ, Nilgün Ulusoy Bozbuğa, Hasan Basri Erdoğan, Deniz Göksedef, *Füsun Güzelmeriç, Kaan Kırali, Cevat Yakut

Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, İstanbul
*Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Anestezi ve Reanimasyon Kliniği, İstanbul

Backgorund: Complete arterial revascularization has become a favoured surgical treatment for coronary artery disease because of the excellent long-term patency of the arterial grafts when compairing the venous grafts.

Methods: From June 1998 - December 2002, radial artery (RA) sequential anastomosis technique was used in 65 patients. The patients was diveded into two groups as performing of proximal anastomosis to the ascending aorta (Group A, n = 49) and to the left internal mammmary artery (LIMA) (Group T, n = 15). The patients were two-vessel (18.7%) or tripple-vessel (81.3%) coronary disease. No patients with tripple-vessel coronary disease in Group A underwent complete arterial revascularization . Six patients of 13 patients with tripple-vessel coronary disease in Group T underwent complete arterial revascularization .

Results: Complete arterial revascularization was prominent in Group T with a rate of 46% when compaired to the other group. Also, the number of the graft/per patients in Group T was less than graft other group (2.6 ± 0.6 versus 2.2± 4 ( p= 0.003). There was neither mortality nor morbidity in both of the groups. Low cardiac output detected in three cases in Group A (6.1%) and in one case (6.7%) in Group T ( p= 0.67). Peropertive myocardial infarction occurred in two cases in Group A (4.8%). The angiographic controls were performed in the patients Group A and Group T 13 ± 8.5 and 9 ± 5.1 months later postoperatively. The patency rates of LIMA and RA grafts were detected in the Groups A and T 95% and 90%, 90% and 60%, respectively.

Conclusions: In sequential grafting technique, the patency rate of radial artery grafts with proximal anastomosis to the ascending aorta are superior than those with proximal anastomosis to the LIMA. Although this findings need to be supported with a large series, the radial artery sequential technique with proximal anastomosis to the ascending aorta is a reliable and effective method in coronary artery surgery.

Keywords : Radial artery, squential grafting, arterial revascularization, coronary artery bypass grafting, T-graft

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