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Mid-term Outcomes of Left Internal Mammary Artery to Radial Artery or Saphenous Vein Y-Composite Grafts in Minimally Invasive Direct Coronary Artery Bypass Grafting for Elderly Patients
Ju Mei, Zhao-lei Jiang, Min Tang, Fangbao Ding, Nan Ma, Chunrong Bao, Junwen Zhang, Hao Liu.
Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong Univers, Shanghai, China.

OBJECTIVE: Minimally invasive direct coronary artery bypass grafting (MIDCAB) has been widely used in the treatment of single vessel disease, but the results for multiple vessel disease are unclear. Here, we report the mid-term outcomes achieved by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) Y-composite grafts in MIDCAB for elderly patients with multiple vessel disease.
METHODS: From January 2009 to December 2013, 32 patients (≥ 70 years, 23 male) with multiple vessel disease underwent MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts without cardiopulmonary bypass in our hospital. MIDCAB was performed through a left anterior minithoracotomy. All significantly narrowed and graftable coronary vessels were bypassed. Nineteen patients used LIMA-RA grafts, and thirteen patients used LIMA-SV grafts. LIMA was grafted to left anterior descending coronary artery in all patients. Multidetector computed tomography was performed to evaluate the patency of grafts at every year postoperatively.
RESULTS: All patients successfully underwent MIDCAB with LIMA-SV or LIMA-RA Y-composite grafts. No patient required to convert to strenotomy during the surgery. Mean operation time was 183.19±13.90 min. Revascularization was performed for 2 target vessels in 7 cases and 3 target vessels in 25 cases. Thirty-day mortality was 3.13% (1/32). There was no acute myocardial infarction or stroke. Mean postoperative ventilation time was 28.28±35.94 hours (8~162 hours). Mean ICU time was 2.97 ± 2.21 days (2~13 days), and mean postoperative inhosptial time was 12.09 ± 3.3 days (7~25 days). At a follow-up of 12 to 71 months, no patients received repeat revascularization. One patient died for heart failure at 29 months postoperatively. The overall survival at 1 and 3 years postoperatively was 96.9±3.1% and 90.4±6.9%. The patency rate of LIMA was 100%. The overall patency rate of RA or SV grafts at 1 and 3 years postoperatively was 96.8±3.2% and 90.7±6.6%.
CONCLUSIONS: MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts is a safe and effective procedure with favorable mid-term outcomes for elderly patients with multiple vessel disease. LIMA-SV composite graft can be used as an alternative graft for patients whose RA and right internal mammary artery are not possible or advisable.


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