OPERATIVE TECHNIQUES AND APPROACHES IN COMPLETE ARTERIAL REVASCULARIZATION IN MULTIVESSEL CORONARY ARTERY DISEASE. Review

Abstract

Relevance. Multi arterial bypass surgery comprises nearly 10% of the overall operations for ischemic heart disease. Multiple studies proved the superiority of arterial grafts for multivessel coronary artery disease. Nevertheless, the vast majority of conduits utilized for multiple bypasses are saphenous vein grafts. With the increasing popularity of radial artery utilization, the gastroepiploic artery remains a faded option. So more studies should be conducted for evaluation of the benefits from the gastroepiploic artery in the setting of multi-arterial revascularization. Objective. Presentation of approaches and operative techniques for complete arterial revascularization in patients with multivessel coronary artery disease. Methods. Analytical review of literature on keywords in international scientometric databases Pub Med, Scopus, Web of Science. Search depth 12 years: from 2007 to 2018. Results. The current paper presents operative techniques and approaches to complete arterial revascularization in patients with multivessel coronary artery disease. The internal mammary artery remains the “gold standard” for the left anterior descending artery anastomosis site. Multiple arterial grafting is superior in terms of overall and cardiac survival. Emerging evidence of radial artery high term patency suggests the use of this arterial graft. Bilateral internal artery utilization provides long-term survival. Supplemental radial artery grafting to bilateral internal mammary provides complete arterial revascularization and can be safely used in routine cardiac surgery practice. Gastroepiploic artery proved superior patency rates, compared to saphenous vein grafts. Right coronary artery territory is an ideal anastomotic site for gastroepiploic artery grafting. The inferior epigastric artery may be used in addition to other arterial grafts as free graft or as y- or t-graft in the setting of multivessel coronary atherosclerotic lesions. Conclusion. Complete arterial revascularization provides symptomatic relief from coronary artery disease provides superior patency rates and lowers the incidence of major adverse cardiac events.