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Beating heart revascularization using only bilateral internal thoracic arteries for triple-vessel disease: early angiographic findings.

BACKGROUND
Early postoperative coronary angiography was performed to establish the feasibility of treating patients with triple-vessel disease by performing completely arterial revascularization on the beating heart using only bilateral internal thoracic arteries (ITAs).


METHODS
Between March 2001 and February 2003, 113 patients with triple-vessel disease (age, 62.0 +/- 8.6 years) underwent beating heart revascularization using only the bilateral ITAs. Left ventricular ejection fractions ranged from 23% to 78% (mean, 51.3% +/- 15.1%). The incidence of diabetes mellitus was 46%. Early postoperative coronary artery angiographic follow-up was performed since May 2002 in the last 59 sequential patients.


RESULTS
There were no operative deaths. Perioperative myocardial infarction and postoperative low cardiac output occurred in only 1 patient each. The mean number of distal anastomoses was 3.9 +/- 0.7 per patient. The patency rates were 100% for the left ITA and 98.1% for the right. Competitive flow patterns were present in 25 distal anastomosis sites (10.5%). A multivariate analysis showed that the degree of stenosis (<75%), the extent of focal stenosis of the native coronary artery, and the intraoperative transit-time flow rate (<10 mL/min) were the statistically significant risk factors for competitive flow.


CONCLUSION
This surgical strategy is feasible, is safe, and yields good early angiographic outcomes, even following beating heart revascularization. However, in less significant lesions competitive flow patterns were relatively prevalent, so this technique might be reserved until it is proven to provide good long-term patency and function.