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Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes

Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the...

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Autores principales: Rustenbach, Christian Jörg, Djordjevic, Ilija, Eghbalzadeh, Kaveh, Baumbach, Hardy, Wendt, Stefanie, Radwan, Medhat, Marinos, Spiro Lukas, Mustafi, Migdat, Lescan, Mario, Berger, Rafal, Salewski, Christoph, Sandoval Boburg, Rodrigo, Steger, Volker, Nemeth, Attila, Reichert, Stefan, Wahlers, Thorsten, Schlensak, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9610783/
https://www.ncbi.nlm.nih.gov/pubmed/36295575
http://dx.doi.org/10.3390/medicina58101415
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author Rustenbach, Christian Jörg
Djordjevic, Ilija
Eghbalzadeh, Kaveh
Baumbach, Hardy
Wendt, Stefanie
Radwan, Medhat
Marinos, Spiro Lukas
Mustafi, Migdat
Lescan, Mario
Berger, Rafal
Salewski, Christoph
Sandoval Boburg, Rodrigo
Steger, Volker
Nemeth, Attila
Reichert, Stefan
Wahlers, Thorsten
Schlensak, Christian
author_facet Rustenbach, Christian Jörg
Djordjevic, Ilija
Eghbalzadeh, Kaveh
Baumbach, Hardy
Wendt, Stefanie
Radwan, Medhat
Marinos, Spiro Lukas
Mustafi, Migdat
Lescan, Mario
Berger, Rafal
Salewski, Christoph
Sandoval Boburg, Rodrigo
Steger, Volker
Nemeth, Attila
Reichert, Stefan
Wahlers, Thorsten
Schlensak, Christian
author_sort Rustenbach, Christian Jörg
collection PubMed
description Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the surgical procedure of minimally invasive coronary artery bypass grafting via left minithoracotomy (MICS CABG), is not a treatment option, CABG using the left internal mammary artery as a T-graft with itself may be an effective treatment strategy. Materials and Methods: We reviewed the data from patients treated in Cologne and Tuebingen from 2019 to 2022. We included 40 patients who received left internal mammary artery (LIMA) grafting, and additional T-graft with the LIMA itself. The objective was focused on intraoperative and short-term outcomes. Results: A total of 40 patients were treated with the LIMA-LIMA T-graft procedure with a Fowler score calculated at 20.1 ± 3.0. A total of 37.5% of all patients had lacking venous graft material due to prior vein stripping, and 21 patients presented severe vein varicosis. An overall of 2.6 ± 0.5 distal anastomoses (target vessels were left anterior descending, diagonal, intermediate branch, and/or left marginal ramus) were performed, partly sequentially. Mean flow of LIMA-Left anterior descending (LAD) anastomosis was 59.31 ± 11.04 mL/min with a mean PI of 1.21 ± 0.18. Mean flow of subsequent T-Graft accounted for 51.31 ± 3.81 mL/min with a mean PI of 1.39 ± 0.47. Median hospital stay was 6.2 (5.0; 7.5) days. No incidence of postoperative wound healing disorders was observed, and all patients were discharged. There was one 30-day readmission with a diagnosis of pericardial effusion (2.5%). There was no 30-day mortality within the cohort. Conclusions: Patients requiring surgical myocardial revascularization due to complex two-vessel coronary artery disease (CAD) can be easily managed with LIMA alone, despite an elevated Fowler score and a promising outcome. A prospective study needs to be conducted, as well as longer term surveillance, to substantiate and benchmark the long-term results, as well as the patency rates.
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spelling pubmed-96107832022-10-28 Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes Rustenbach, Christian Jörg Djordjevic, Ilija Eghbalzadeh, Kaveh Baumbach, Hardy Wendt, Stefanie Radwan, Medhat Marinos, Spiro Lukas Mustafi, Migdat Lescan, Mario Berger, Rafal Salewski, Christoph Sandoval Boburg, Rodrigo Steger, Volker Nemeth, Attila Reichert, Stefan Wahlers, Thorsten Schlensak, Christian Medicina (Kaunas) Article Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the surgical procedure of minimally invasive coronary artery bypass grafting via left minithoracotomy (MICS CABG), is not a treatment option, CABG using the left internal mammary artery as a T-graft with itself may be an effective treatment strategy. Materials and Methods: We reviewed the data from patients treated in Cologne and Tuebingen from 2019 to 2022. We included 40 patients who received left internal mammary artery (LIMA) grafting, and additional T-graft with the LIMA itself. The objective was focused on intraoperative and short-term outcomes. Results: A total of 40 patients were treated with the LIMA-LIMA T-graft procedure with a Fowler score calculated at 20.1 ± 3.0. A total of 37.5% of all patients had lacking venous graft material due to prior vein stripping, and 21 patients presented severe vein varicosis. An overall of 2.6 ± 0.5 distal anastomoses (target vessels were left anterior descending, diagonal, intermediate branch, and/or left marginal ramus) were performed, partly sequentially. Mean flow of LIMA-Left anterior descending (LAD) anastomosis was 59.31 ± 11.04 mL/min with a mean PI of 1.21 ± 0.18. Mean flow of subsequent T-Graft accounted for 51.31 ± 3.81 mL/min with a mean PI of 1.39 ± 0.47. Median hospital stay was 6.2 (5.0; 7.5) days. No incidence of postoperative wound healing disorders was observed, and all patients were discharged. There was one 30-day readmission with a diagnosis of pericardial effusion (2.5%). There was no 30-day mortality within the cohort. Conclusions: Patients requiring surgical myocardial revascularization due to complex two-vessel coronary artery disease (CAD) can be easily managed with LIMA alone, despite an elevated Fowler score and a promising outcome. A prospective study needs to be conducted, as well as longer term surveillance, to substantiate and benchmark the long-term results, as well as the patency rates. MDPI 2022-10-09 /pmc/articles/PMC9610783/ /pubmed/36295575 http://dx.doi.org/10.3390/medicina58101415 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Rustenbach, Christian Jörg
Djordjevic, Ilija
Eghbalzadeh, Kaveh
Baumbach, Hardy
Wendt, Stefanie
Radwan, Medhat
Marinos, Spiro Lukas
Mustafi, Migdat
Lescan, Mario
Berger, Rafal
Salewski, Christoph
Sandoval Boburg, Rodrigo
Steger, Volker
Nemeth, Attila
Reichert, Stefan
Wahlers, Thorsten
Schlensak, Christian
Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title_full Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title_fullStr Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title_full_unstemmed Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title_short Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
title_sort treatment of complex two-vessel coronary heart disease with single left internal mammary artery as t-graft with itself—a retrospective double center analysis of short-term outcomes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9610783/
https://www.ncbi.nlm.nih.gov/pubmed/36295575
http://dx.doi.org/10.3390/medicina58101415
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