Total arterial revascularisation (TAR) with radial artery T-grafts (RA-T) in patients with significant left main stem stenosis is not associated with higher perioperative risk

Total arterial revascularisation (TAR) has become a standard procedure for the treatment of multi vessel coronary disease. Using radial artery T-grafts (RA-T) as composite grafts with a in situ left internal thoracic artery (LITA) has led to the concern, that patients with significant left main stem stenosis may have a higher perioperative risk due to single inflow to all bypasses and possible vasospasms of the LITA.

To compare the early postoperative outcome after TAR in patients without (Group A) and with left main stem stenosis (Group B), we reviewed the data of 562 consecutive TAR patients, who underwent first time CABG in our institution between 1996 and 2005.

The incidence of three vessel disease (70.8% vs. 81.1%), preoperative myocardial infarction (37.5% vs. 48.6%) and diabetes (16.7% vs. 33.49%) was significant lower in Group B (P<0.05). In addition Group B patients had a significant higher ejection fraction (59.3% vs. 55.6%). Postoperative data revealed no significant differences in complications such as myocardial infarction (1.4% vs. 1.4%, P=0.64) or low cardiac output (2.1% vs. 2.4%). Group B patients were discharged earlier (8.9 vs. 11.2 days, P<0.05). In hospital mortality was slightly higher in patients with left main stem stenosis (2.1% vs. 1.2%, P=0.44).

TAR using radial artery T-grafts in patients with left main stem stenosis can be achieved at low operative risk. However, low incidence of complications and shorter length of stay may partly be caused by preselection with a lower comorbidity in patients receiving TAR despite of a significant left main disease.