Immediate results of complete conventional and bimammary bypass grafting in patients with multivessel coronary disease

Authors: Muradov A.G., Drobot D.B., Grinshteyn Yu.I., Sakovich V.A., Andin A.V.

Company: 1Federal Center for Cardiovascular Surgery, Krasnoyarsk, Russian Federation
2Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2022-16-3-355-369

For citation: Muradov A.G., Drobot D.B., Grinshteyn Yu.I., Sakovich V.A., Andin A.V. Immediate results of complete conventional and bimammary bypass grafting in patients with multivessel coronary disease. Creative Cardiology. 2022; 16 (3): 355–69 (in Russ.). DOI: 10.24022/1997-3187-2022-16-3-355-369

Received / Accepted:  16.05.2022 / 15.09.2022

Keywords: coronary artery bypass grafting complete myocardial revascularization bimammary bypass grafting

Full text:  

 

Abstract

Objective. Compare the immediate results of conventional and bimammary bypass grafting in patients with multivessel coronary disease.

Material and methods. From January 2018 to December 2021, 646 coronary artery bypass grafting operations were performed in the FCCS (Krasnoyarsk) in patients with coronary artery disease and multivessel coronary disease. Group 1 (n = 178) consisted of patients in whom both internal mammary arteries were used for complete myocardial revascularization, group 2 (n = 468), where the traditional revascularization technique was used. After propensity score matching, 178 patients were selected in each group. Male patients dominated both groups: 152 (85%) and 160 (90%) (p = 0.259), matched by age: 61.2 ±7.4 and 61.2 ± 7.2 (p = 0.768). In group 1, operations were performed both under conditions of cardiopulmonary bypass (1 on pump) and under conditions of a beating heart (1 off pump).

Results. In group 1, 99 (55.6%) patients underwent surgery under on pump conditions, 79 (44.4%) patients under off pump conditions, and in group 2, all operations were performed under on pump conditions (100%). In-hospital mortality was 3 (3%) in group 1 on pump and 3 (1.7%) in group 2 (p > 0.670). There was no statistical difference between group 2 and groups 1 on pump and 1 off pump in perioperative myocardial infarction (p > 0.999 and p > 0.999), number of bypassed arteries (p = 0.359 and p = 0.790), deep sternal wood infection complicated in 1 (1%) patient in the group 1 on pump (p = 0.357) and in 2 (2.5%) in the group 1 off pump (p = 0.094).

Conclusion. Bimammary bypass grafting is a modern effective method of myocardial revascularization both under cardiopulmonary bypass and under conditions of a beating heart, may be the operation of choice for the surgical treatment of patients with multivessel coronary artery disease.

References

  1. Harskamp R.E., Alexander J.H., Ferguson T.B.Jr., Hager R., Mack M.J., Englum B. et al. Frequency and predictors of internal mammary artery graft failure and subsequent clinical outcomes: insights from the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial. Circulation. 2016; 133 (2): 131–8. DOI: 10.1161/CIRCULATIONAHA.115.015549
  2. Loop F.D., Lytle B.W., Cosgrove D.M., Stewart R.W., Goormastic M., Williams G.W. et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N. Engl. J. Med. 1986; 314 (1): 1–6. DOI: 10.1056/nejm198601023140101
  3. Бокерия Л.А., Гудкова Р.Г. Сердечно-сосудистая хирургия – 2015. Болезни и врожденные аномалии системы кровообращения. М.: НЦССХ им. А.Н. Бакулева РАМН; 2016. Bockeria L.A., Gudkova R.G. Cardiovascular Surgery – 2015. Diseases and congenital anomalies of the circulatory system. Moscow; 2016 (in Russ.).
  4. Cuminetti G., Gelsomino S., Curello S., Lorusso R., Maessen J.G., Hoorntje J.C.A. Contemporary use of arterial and venous conduits in coronary artery bypass grafting: anatomical, functional and clinical aspects. Neth. Heart. J. 2016; 25 (1): 4–13. DOI: 10.1007/s12471-016-0919-2
  5. Ben-Gal Y., Gordon A., Ziv-Baran T., Farkash A., Mohr R., Kramer A. et al. Late outcomes of in situ versus composite bilateral internal thoracic artery revascularization. Ann. Thorac. Cardiovasc. Surg. 2021; 112 (5): 1441–6. DOI: 10.1016/j.athoracsur.2020.11.041
  6. Buttar S.N., Yan T.D., Taggart D.P., Tian D.H. Long-term and short-term outcomes of using bilateral internal mammary artery grafting versus left internal mammary artery grafting: a meta-analysis. Heart. 2017; 103 (18): 1419–26. DOI: 10.1136/heartjnl-2016-310864
  7. Ji Q., Xia L., Shi Y., Ma R., Shen J., Lai H. et al. Mid-term graft patency of right versus left internal mammary artery as arterial conduit usage for left anterior descending artery revascularisation: insights from a single-centre study of propensitymatched data. Int. J. Surg. 2017; 48: 99–104. DOI: 10.1016/j.ijsu.2017.10.037
  8. Raja S.G., Benedetto U., Husain M., Soliman R., De Robertis F., Amrani M. Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage? J. Thorac. Cardiovasc. Surg. 2014; 148 (4): 1275–81. DOI: 10.1016/j.jtcvs.2013.11.045
  9. D’Agostino R.S., Jacobs J.P., Badhwar V., Paone G., Rankin J.S., Han J.M., et al. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: update on outcomes and quality. Ann. Thorac. Cardiovasc. Surg. 2016; 101 (1): 24–32. DOI: 10.1016/j.athoracsur.2015.11.032
  10. Hattler B., Grover F.L., Wagner T., Hawkins R.B., Quin J.A., Collins J.F. et al. Incidence and prognostic impact of incomplete revascularization documented by coronary angiography 1 year after coronary artery bypass grafting. Am. J. Cardiol. 2020; 131: 7–11. DOI: 10.1016/j.amjcard.2020.06.047
  11. Royse A., Pawanis Z., Canty D., Ou-Young J., Eccleston D., Ajani A. et al. The effect on survival from the use of a saphenous vein graft during coronary bypass surgery: a large cohort study. Eur. J. Cardiothorac. Surg. 2018; 54 (6): 1093–100. DOI: 10.1093/ejcts/ezy213
  12. Niclauss L. Techniques and standards in intraoperative graft verification by transit time flow measurement after coronary artery bypass graft surgery: a critical review. Eur. J. Cardiothorac. Surg. 2016; 51 (1): 26–33. DOI: 10.1093/ejcts/ezw203
  13. Taggart D.P., Altman D.G., Gray A.M., Lees B., Nugara F., Yu L. et al. Randomized trial to compare bilateral vs. single internal mammary coronary artery bypass grafting: 1-year results of the Arterial Revascularisation Trial (ART). Eur. J. Heart. Fail. 2010; 31 (20): 2470–81. DOI: 10.1093/eurheartj/ehq318
  14. Rocha R.V., Tam D.Y., Karkhanis R., Wang X., Austin P.C., Ko D.T. et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization. Eur. Heart. J. Case Rep. 2020; 5 (5): 507–14. DOI: 10.1001/jamacardio.2019.6104
  15. DeSimone J.P., Malenka D.J., Weldner P.W., Iribarne A., Leavitt B.J., McCullough J.N. et al. Coronary revascularization with single versus bilateral mammary arteries: is it time to change? Ann. Thorac. Cardiovasc. Surg. 2018; 106 (2): 466–72. DOI: 10.1016/j.athoracsur.2018.01.089
  16. Fomenko M.S., Schneider Y.A., Tsoi V.G., Pavlov A.A., Shilenko P.A. Left or bilateral internal mammary artery employment in coronary artery bypass grafting: midterm results. Asian Cardiovasc. Thorac. Ann. 2021; 29 (8): 758–62. DOI: 10.1177/0218492321990764
  17. Lemaignen A., Birgand G., Ghodhbane W., Alkhoder S., Lolom I., Belorgey S. et al. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Clin. Microbiol. Infect. 2015; 21 (7): 674.e11–8. DOI: 10.1016/j.cmi.2015.03.025
  18. Bonacchi M., Prifti E., Bugetti M., Parise O., Sani G., Johnson D.M. et al. Deep sternal infections after in situ bilateral internal thoracic artery grafting for left ventricular myocardial revascularization: predictors and influence on 20-year outcomes. J. Thorac. Dis. 2018; 10 (9): 5208–21. DOI: 10.21037/jtd.2018.09.30
  19. Benedetto U., Altman D.G., Gerry S., Gray A., Lees B., Pawlaczyk R. et al. Arterial revascularization trial investigators. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: insights from the Arterial Revascularization Trial. J. Thorac. Cardiovasc. Surg. 2016; 152: 270–6. DOI: 10.1016/j.jtcvs.2016.03.056
  20. Matsuura K., Jin W.W., Liu H., Matsumiya G. Computational fluid dynamics study of the endside and sequential coronary artery bypass anastomoses in a native coronary occlusion model. Interact. Cardiovasc. Thorac. Surg. 2017; 26 (4): 583–9. DOI: 10.1093/icvts/ivx376
  21. Kim H.J., Lee T.Y., Kim J.B., Cho W.C., Jung S.H., Chung C.H. et al. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. J. Thorac. Cardiovasc. Surg. 2011; 141 (3): 750–4. DOI: 10.1016/j.jtcvs.2010. 05.037
  22. Mehta R.H., Ferguson T.B., Lopes R.D., Hafley G.E., Mack M.J., Kouchoukos N.T. et al. Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV Trial. Circulation. 2011; 124 (3): 280–8. DOI: 10.1161/circulationaha.110.99

About Authors

  • Asim G. Muradov, Cardiovascular Surgeon; ORCID
  • Dmitriy B. Drobot, Dr. Med. Sci., Professor, Head of the Scientific and Methodological Department, Doctor-Methodologist; ORCID
  • Yuriy I. Grinshteyn, Dr. Med. Sci., Professor, Chief of Chair; ORCID
  • Valeriy A. Sakovich, Dr. Med. Sci., Professor, Chief of Chair and Clinic, Chief Physician; ORCID
  • Aleksey V. Andin, Cand. Med. Sci., Cardiovascular Surgeon, Head of Department; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery