Complete Arterial Revascularization Shows Excellent Results after 20 Years of Follow-up

Background: To analyze the 20-year results of complete arterial revascularization using bilateral mammary arteries (BIMA) and identify independent risk factors for long-term adverse results.

Method: In this single-center retrospective cross-sectional study, all patients who underwent a complete arterial coronary revascularization of a three-vessel disease using BIMA to all three coronary territories from January 1999 to December 2000 were screened for inclusion. Reoperations, patients with missing perioperative data, and patients who were lost to follow-up were excluded. The primary endpoint was all-cause mortality. The secondary endpoints were cardiac mortality, myocardial infarction, stroke, and repeat revascularization.

Results: A total of 883 patients were screened and 338 met the inclusion criteria. 86 patients were lost to follow-up and 252 were included in the study (74.6%). The mean age at the time of surgery was 63 years. The overall 5-, 10-, 15-, and 20-year survival rates were 93, 78, 58, and 39%, respectively. A cardiac cause of death was documented in 31% of deaths. The 5-, 10-, 15-, and 20-year freedom from ischemic adverse events were 98, 93, 87, and 81.3% for infarction and 96, 88, 83, and 80% for stroke. The multivariable analysis revealed only age as an independent risk factor for all-cause mortality (p < 0.001) and postoperative infarction an independent risk factor for cardiac death (p = 0.02). A total of 110 patients underwent coronary angiography over the follow-up period. The mean time till angiography was 11.5 years. The left mammary artery to the left anterior descending and diagonal branches patency rates were 85 and 86%, respectively. The right mammary artery to diagonal branch, intermediate branch, obtuse marginal, and right posterolateral and posterior descending artery patency rates were 100, 91, 93, 82, and 77%, respectively. The overall repeat revascularization rate was 19% after 20 years. One patient underwent redo surgery, while other patients underwent percutaneous interventions (PCI).

Conclusion: Complete arterial revascularization demonstrates excellent long-term results even after 20 years. The patency rates of the right mammary to the circumflex and right coronary territories are excellent and comparable to the gold standard of the left mammary to the anterior descending artery. In the era of aggressive primary PCI, complete arterial revascularization should be the standard of care in three-vessel disease to achieve optimal long-term results.

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Artikel online veröffentlicht:
28. Januar 2023