European Journal of Cardio-Thoracic Surgery, Vol 11, 140-148, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Mid-term follow-up of 183 arterial myocardial revascularization procedures
C Antona, M Zanobini, AA Lotto, A Parolari, F Alamanni and P Biglioli
Department of Cardiac Surgery, Centro Cardiologico Fondazione I Monzino IRCCS, University of Milan, Italy.
OBJECTIVE: To evaluate the mid-term results of complete arterial myocardial
revascularization performed with arterial conduits. METHODS: From July 1987
to December 1994, 183 patients underwent a myocardial revascularization
procedure with the use of at least two arterial grafts (IMAs, rGEA, IEA) at
our institute. Their mean age was 56 +/- 8.7 years, the redo-operation rate
was 16.9% (31/183), two-vessel disease was present in 61 patients (33.3%),
three-vessel disease in 122 (66.7%). RESULTS: The LIMA was used in 179
patients (97.8%), the RIMA in 116 (63.4%), the rGEA in 66 (36.1%) and the
IEA in 41 (22.4%). In- hospital mortality was 1.1% (2/183), while the
perioperative myocardial infarction (MI) rate was 2.2% (4/183). The
angiographic restudy, performed on 87 (47.5%) patients during the early
postoperative period (median 38 days) showed the following grafts patency
rates: LIMA 98.8 (86/87), RIMA 97.1 (34/35), IEA 85.7 (24/28), rGEA 97.05
(33/34) and saphenous vein 90.9% (10/11). The median follow-up was 35
months. Kaplan-Meier survival was 96 +/- 2% at 3 and 5 years, freedom from
angina 94 +/- 2% at 3 years and 91 +/- 3% at 5 years, while the Kaplan-
Meier freedom from cardiac events was 90 +/- 3% at 3 years and 88 +/- 3% at
5 years. Cox regression analysis identified perioperative MI (P = 0.03,
relative risk 3.6) as the only prognostic factor for mortality at
follow-up. With regards to recurrence of angina, multivariate analysis has
shown that incremental risk factors for the return of angina are
redo-operation (P < 0.01, relative risk 2.7) and the persistence of
hypertension after surgery (P < 0.01; relative risk 3.2), while the use
of the RIMA in the operation has emerged as a protective factor (P = 0.02;
relative risk 0.43). Finally, only redo-operation (P < 0.01; relative
risk 2.3), has emerged as a predictor of cardiac complications. CONCLUSION:
Myocardial revascularization with at least two arterial grafts can be
performed with very low perioperative morbidity and mortality and good
mid-term follow-up. The mid-term results of arterial myocardial
revascularization are less favourable in cases of redo-operations or when
the RIMA is not used.
