الفهرس 
ANATOMY AND HISTOPATHOLOGY OF THE RADIAL ARTERYOnly 14 pages are availabe for public view
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Abstract
Background: Total arterial revascularization offers a potential to avoid
the problems associated with vein graft failure. We aimed to evaluate the
benefits of using composite grafts in Tor Y fashion: free RA implanted on
intact full-pedicle LIMA ;versus using skeletonized RIMA implanted in T or Y
fashion on intact skeletonized LIMA for adequate revascularization of the left
coronary artery branches
Patients and methods: This randomized prospective comparative study
enrolled 100 male ischemic heart disease patients who were submitted for
elective isolated CABG surgery using conventional CPB and antegrade
intermittent warm blood cardioplegia. Patients were allocated into two equal
groups :Group A encompassed 50 patients with mean age was 47 ± 1.8 years
(range, 41 to 64 years) in whom intact full-pedicle left internal mammary artery
(LIMA) was grafted to the LAD coronary vessel, and free pedicled RA grafts
to revascularize left coronary branches from the LIMA in a Tor Y fashion, and
a free SVG from the aorta to the branches of the right coronary system. The RA
grafts were managed according to the Hong-Kong University protocol. In
group B,50 patients with mean age was 43 ± 2.2 years (range, 42 to 61 years)
received a free skeletonized RIMA graft between the left coronary branches
and LIMA which was skeletonized and implanted to the LAD. Follow-up was
complete for all cases . Data were prospectively collected in both groups.
Results were analyzed by clinical assessment and special investigation as ECG,
Lab enzymes, and Echocardiography, both intraoperatively and during the inhospital
patient stay.
Results: The mean total operative time was 2.5±0.3 hours (range 2.4-4.5
hours) for group A, versus 4.0± 0.5 hours (range 3.5-5.5 hours) for group B.
The mean cardiopulmonary bypass time was 70±11 minutes (range 65-120
minutes) for group A , versus 75 ± 8 minutes (range 69 -127 minutes) in group
B. The mean aortic occlusion (ischemic) time was 48±9 minutes (range 33-39
minutes) for group A, versus 52±6 minutes (range 40-102 minutes) for group
B. In group A 3±0.2 distal anastomotic points were fashioned in each patient
versus 3±0.3 in group B. There was no operative incidence of new ischemic
pain: perioperative myocardial infarction; cerebral stroke or renal failure or
neurovascular hand complication. There was no need for Inotropic support or
IABP during the post operative course. Patients of group B needed a longer
ICU time (statistically significant) with a mean of 45±3.4 hours (range 30-49
x
hours); versus 35±2.3 hours (range 24-38 hours) for group A patients. The time
spent by the patient on mechanical ventilation was longer (statistically
significant) in group B patients with a mean of 13±1 hours ranging between 8-
14 hours: versus mean of 8 ±1.1 hours ranging between 6-10 hours for group A
patients. The amount of pleuro-mediastinal blood loss was more (statistically
significant) in group B patients with mean of 688 ± 250 mls ranging between
500-1500 mls: versus mean of 460 ± 160 ranging between 300-1000 for group
A patients. The amount of blood transfusion was more (statistically
significant) in group B patients with mean of 1.26 ± 0.853 units ranging
between 1-4 units: versus mean of 0.90 ± 0.6 ranging between 1-3 for group A
patients. The total hospital stay time was longer (statistically significant) in
group B patients ranging from 8-14 days with a mean of 9 ±1.5 days; versus 5-
12 days with a mean of 5±1 days for group A patients. No mortality occurred
in both groups with morbidity occurred in13 patients (13%): 11 in group B
(22%) and 2 (4%) in group A. One of group A patients (2%) showed
superficial forearm wound infection and reopening for bleeding occurred in 1
patient (2%); versus 4 of group B patients (8%) complained of atrial fibrillation
(AF), deep sternal wound infection in 3(6%) patients and reopening for
bleeding occurred in 4 patients (8%).
Conclusion: We concluded that LIMA-RA composite grafts (as T or Y
configuration) allowed safe and adequate revascularization of the left coronary
system, compared to composite skeletonized RIMAs (as T or Y configuration)
in the early term outcome. Our results supports the effectiveness and safety of
its use and recommend its application in CABG surgery to improve the early
surgical outcome.
KEYWORDS:
Coronary Artery Bypass Grafting, Left Internal Thoracic, Radial
Arteries, Bilateral Skeletonized Internal Thoracic Arteries