Universität zu Köln

Rustenbach, Christian Joerg, Djordjevic, Ilija ORCID: 0000-0002-5810-8626, Eghbalzadeh, Kaveh, Baumbach, Hardy, Wendt, Stefanie, Radwan, Medhat, Marinos, Spiro Lukas, Mustafi, Migdat, Lescan, Mario, Berger, Rafal, Salewski, Christoph, Boburg, Rodrigo Sandoval, Steger, Volker, Nemeth, Attila, Reichert, Stefan, Wahlers, Thorsten and Schlensak, Christian (2022). Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself-A Retrospective Double Center Analysis of Short-Term Outcomes. Med. Lith., 58 (10). BASEL: MDPI. ISSN 1648-9144

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Abstract

Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the surgical procedure of minimally invasive coronary artery bypass grafting via left minithoracotomy (MICS CABG), is not a treatment option, CABG using the left internal mammary artery as a T-graft with itself may be an effective treatment strategy. Materials and Methods: We reviewed the data from patients treated in Cologne and Tuebingen from 2019 to 2022. We included 40 patients who received left internal mammary artery (LIMA) grafting, and additional T-graft with the LIMA itself. The objective was focused on intraoperative and short-term outcomes. Results: A total of 40 patients were treated with the LIMA-LIMA T-graft procedure with a Fowler score calculated at 20.1 +/- 3.0. A total of 37.5% of all patients had lacking venous graft material due to prior vein stripping, and 21 patients presented severe vein varicosis. An overall of 2.6 +/- 0.5 distal anastomoses (target vessels were left anterior descending, diagonal, intermediate branch, and/or left marginal ramus) were performed, partly sequentially. Mean flow of LIMA-Left anterior descending (LAD) anastomosis was 59.31 +/- 11.04 mL/min with a mean PI of 1.21 +/- 0.18. Mean flow of subsequent T-Graft accounted for 51.31 +/- 3.81 mL/min with a mean PI of 1.39 +/- 0.47. Median hospital stay was 6.2 (5.0; 7.5) days. No incidence of postoperative wound healing disorders was observed, and all patients were discharged. There was one 30-day readmission with a diagnosis of pericardial effusion (2.5%). There was no 30-day mortality within the cohort. Conclusions: Patients requiring surgical myocardial revascularization due to complex two-vessel coronary artery disease (CAD) can be easily managed with LIMA alone, despite an elevated Fowler score and a promising outcome. A prospective study needs to be conducted, as well as longer term surveillance, to substantiate and benchmark the long-term results, as well as the patency rates.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rustenbach, Christian Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Djordjevic, Ilija UNSPECIFIED orcid.org/0000-0002-5810-8626 UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Baumbach, Hardy UNSPECIFIED UNSPECIFIED UNSPECIFIED Wendt, Stefanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Radwan, Medhat UNSPECIFIED UNSPECIFIED UNSPECIFIED Marinos, Spiro Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Mustafi, Migdat UNSPECIFIED UNSPECIFIED UNSPECIFIED Lescan, Mario UNSPECIFIED UNSPECIFIED UNSPECIFIED Berger, Rafal UNSPECIFIED UNSPECIFIED UNSPECIFIED Salewski, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Boburg, Rodrigo Sandoval UNSPECIFIED UNSPECIFIED UNSPECIFIED Steger, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Nemeth, Attila UNSPECIFIED UNSPECIFIED UNSPECIFIED Reichert, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlensak, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-669513
DOI:	10.3390/medicina58101415
Journal or Publication Title:	Med. Lith.
Volume:	58
Number:	10
Date:	2022
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	1648-9144
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STERNAL WOUND-INFECTION; SURGERY Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/66951