Clinical validation of a coronary surgery technique that minimizes aortic manipulation.

BACKGROUND: To minimize aortic manipulation and maximize use of arterial conduits are aims of modern coronary surgery.

METHODS: From March 2012 to October 2016, 890 consecutive patients with multivessel coronary disease underwent isolated coronary surgery using both internal thoracic arteries (ITAs). In 205 (23%; mean age, 67.6±9.2 years), the right ITA was proximally transected and used as free graft, while its in situ stump was elongated with a saphenous vein graft. The new arteriovenous I-conduit was directed to the inferolateral cardiac wall. Operative data and early outcomes of these patients (I-group) were compared with the remaining 685 patients (C-group). Early and late outcomes were compared also in 184 pairs identified with the propensity score-matching.

RESULTS: Between I and C-group there was no significant difference on expected operative risk (European System for Cardiac Operative Risk Evaluation II, p=0.28), though diseased ascending aorta (p<0.0001) and critical preoperative state (p=0.027) were more frequent in I-group. Despite higher number of coronary anastomoses (mean, 4±0.9 vs. 3.7±1, p<0.0001), cardiopulmonary bypass time (minutes) was shorter in I-group both in overall (86.7±23.7 vs. 105.7±34.2, p<0.0001) and matched series (86.8±24.1 vs. 108.8±31.9, p<0.0001). In-hospital mortality (1% vs. 1.9%, p=0.54) and the rates of postoperative complications were similar. During the follow-up period, in matched patients, no intergroup difference was found about the non-parametric estimates of freedom from all-cause death (p=0.39) and major adverse cardiac and cerebrovascular events (p=0.44).

CONCLUSIONS: Surgery using this arteriovenous I-conduit is safe, minimizes aortic manipulation, makes shorter cardiopulmonary bypass time, and aids complete revascularization.