Mid-term follow-up of 183 arterial myocardial revascularization procedures

Objective. To evaluate the mid-term results of complete arterial myocardial revascularization performed with arterial conduits. Methods: From July 1987 to December 1994, 153 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 ± 30% 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.