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Surgical myocardial revascularization for three-vessel coronary artery disease: the importance of the surgical technique to the clinical outcome

Objective: The effect of two different coronary surgical revascularization techniques featuring skeletonized double mammary artery (BIMA) as T-graft, on the postoperative evolution of functional mitral valve regurgitation (MVR) is studied. Methods: Early postoperative and mid-term outcome of...

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Bibliographic Details
Main Author: Vasiloi, Ion
Contributors: Andrasi-Wensauer, Terezia (PD Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Language:English
Published: Philipps-Universität Marburg 2023
Subjects:
Koronare Dreigefäßerkrankung
comparison
surgical technique
Coronary artery disease
Chirurgische Technik
3-GE-KHK
Chirurgische Revaskularisation
Medizin
Ergebnis
BIMA
KHK3
T-Graft
Vergleich
Koronare Herzkrankheit
three-vessel coronary artery disease
outcome
clinical results,
Operationstechnik,
CAD
3v-CAD
Medical sciences Medicine
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Summary:Objective: The effect of two different coronary surgical revascularization techniques featuring skeletonized double mammary artery (BIMA) as T-graft, on the postoperative evolution of functional mitral valve regurgitation (MVR) is studied. Methods: Early postoperative and mid-term outcome of complete BIMA revascularization (BIMA T-Graft) versus left-sided BIMA with right-sided aorto-coronary bypass (T-Graft + RACB) is analyzed by multivariable logistic regression, Cox-regression and Kaplan-Meier analysis in a series of 204 consecutive patients treated for triple-vessel coronary disease (3v-CAD). Results: The T-Graft + RACB technique (n=104) enables higher number of total (4.02±0.87 vs. 3.71±0.69, p=0.015) and right-sided (1.21±0.43 vs. 1.02±0.32, p=0.001) coronary anastomoses and improves total bypass flow (125.88±92.41 vs. 82.50±49.26ml, p<0.0001), bypass flow/anastomosis (31.83±23.9 vs.22.77±14.23, p=0.001) and completeness of revascularization (84% vs.69%, p=0.014) compared to BIMA T-Graft strategy (n=100), respectively. The BIMA T-Graft strategy (HR=4.2, p=0.01) and preoperative presence of RCA occlusion (HR=3.006, p=0.023) are relevant risk factors of MVR-progression, while T-Graft + RACB technique protects against MVR-progression (X2= 14.04, p <0.0001) independent of the preoperative anatomic complexity (Syntax-score I: HR=16.2, p=0.156), of comorbidities (Syntax-score II: HR=1.901, p=0.751; Euroscore-II: HR=0.00, p=0.680), and without enhancing MACCE at 30-days (0.02% vs.0.08%, p=0.055), early mortality (0.96% vs.2%, p=0.617) and mortality at 5-years (5.8% vs.4%, p=0.748) when compared to BIMA T-Graft, respectively. Conclusions: MVR worsened more after revascularization with BIMA T-Graft technique. When treating 3v-CAD, surgical replication of anatomical traits by providing two-inflow coronary revascularization, such as accomplished with the T-Graft + RACB technique, leads to improved completeness of revascularization and attenuates the postoperative progression of MVR independently of Syntax-scores and without increasing the risk for MACCE.
DOI:10.17192/z2023.0628

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