Coronary-coronary bypass graft: An arterial conduit–sparing procedure

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 112; no. 5; pp. 1223 - 1230
• Main Authors: Nottin, R., Grinda, J.M., Anidjar, S., Folliguet, T., Detroux, M.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.11.1996; AATS/WTSA
• Subjects: Adult; Aged; Aged, 80 and over; Coronary Artery Bypass - methods; Coronary Disease - surgery; Female; Humans; Male; Middle Aged; Radial Artery - transplantation; Reoperation; Saphenous Vein - transplantation; Thoracic Arteries - transplantation
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/S0022-5223(96)70135-6

From May 1989 to December 1995, 143 patients underwent myocardial revascularization with one (138 patients) or two (five patients) coronary-coronary bypass grafts in addition to other bypass grafts, for a total of 463 distal anastomoses (mean 3.2 ± 0.6 per patient). Coronary-coronary bypass grafts were chosen for the following reasons: arterial conduit–sparing procedure, inadequate length for in situ graft, calcified ascending aorta, and stenosed or occluded subclavian arteries. One hundred eleven arterial grafts (75%) were used: 85 right internal thoracic arteries, 18 left internal thoracic arteries, and eight radial arteries. Saphenous vein grafts were used in 37 cases (25%, mostly in our early experience). Coronary-coronary bypass grafts were performed on the right coronary artery in 134 cases (90.5%), on the circumflex artery in five cases (3.3%), on the left anterior descending coronary artery in four cases (2.7%), and between two different coronary arteries in five cases (3.3%). Three patients (2%) died of myocardial infarction. Early postoperative angiography showed a patency rate of 98.6% (72/73). During the mean follow-up of 34.6 ± 20.8 months, two patients died and two underwent reoperation. Results of exercise testing were normal at 2 months in 97% of patients (90/92), at 1 year in 96% (81/84), and at 3 years in 93% (30/32). In conclusion, the coronary-coronary bypass graft provides good results with a variety of conduits and allows the expanded use of arterial grafts, particularly the internal thoracic artery. This can lead to a sparing of arterial conduit and allow complex myocardial revascularization with a liberal use of internal thoracic arteries. (J T HORAC C ARDIOVASC S URG 1996;112:1223-30)