Immediate results of using both internal thoracic arteries for coronary artery bypass surgery in patients with ischemic artery disease

Abstract

Objective: To compare direct results of «in situ» and Y-graft bimammary autoarterial bypass in patients having coronary artery disease.Methods:  From January 2018 to November 2020, 107 patients having ischemic artery disease undergone coronary artery bypass surgery in the Cardiac Surgery Department No.1 of the Federal State Budgetary Institution "Federal Center for Cardiovascular Surgery" of the Ministry of Health of the Russian Federation (Krasnoyarsk). The distribution of the groups was carried out in a 3:1 ratio: in the first group (24 patients) both internal thoracic arteries were used for myocardial revascularization according to the «in situ» technique, in the second group (composite bypass surgery) (83 patients) the right internal thoracic artery was anastomosed with a free graft with the left internal thoracic artery (Y- graft).Results: There were no cases of hospital mortality. The duration of operations in the composite bypass group was significantly higher than in the «in situ» group (126.4  minutes ± 20.1 minutes versus 172.3 minutes ± 27.1 minutes, p = 0.038). The reason for extra time is the necessity to put a large number of distal anastomoses. Bleeding in the early postoperative period was observed only in one case (1.2%) in the composite bypass group. Perioperative myocardial infarctions, neurological complications, and deep wound infection of the sternum weren't observed in any group. One patient from the «in situ» group (4.2%) and one patient from the composite bypass grafting group (1.2%), experienced the postoperative period complicated by a superficial wound infection in the area of the sternotomy access (p = 0.649). In the «in situ» group, average blood flow velocity according to flowmetry data was 32 ml / min ± 8.1 ml / min, and in the composite shunting group it counted 51.8 ml / min ± 12.3 ml / min, p = 0.001.Conclusions. Using both internal thoracic arteries for coronary artery bypass surgery provides a favorable effect of surgical treatment in the postoperative period. This operation technique can be safely performed with low mortality rate and less complications. It may be associated with improved long-term patient survival; but this requires further analysis of the study results in a longer period.