Total arterial revascularization in patients with concomitant aortic valve stenosis. Is this strategy safe?

Introduction: This study was undertaken to evaluate the safety of total arterial revascularization (TAR) with the left internal thoracic artery (LITA) and the radial artery (RA) T-graft in patients with multiple coronary artery disease and aortic Valve stenosis undergoing concomitant aortic valve replacement (AVR) in comparison with matched cohort of patients who received conventional CABG with the LITA and additional vein grafts and simultaneous AVR.

Methods: From June 2001 to January 2005, 18 patients underwent AVR and TAR with LITA/RA T-graft and 101 patients underwent AVR and conventional CABG with LITA and saphenous vein grafts. By matching according to age, sex, left ventricular ejection fraction, and number of distal anastomoses, 1 : 2 matched groups were generated; 15 patients with LITA/RA T-graft (T-Graft group) and 30 patients with LITA and additional vein grafts (Conventional group). Three patients with T-graft who had only 1 matched patient were excluded. There were no statistically significant differences of any factor between these groups.

Results: The aortic cross-clamp time and Cardiopulmonary Bypass (CPB) time were not different between the groups. Early mortality was 0% in T-group and 2% in conventional group (p=.47). There were no statistical differences in postoperative ventilation time and early complications between the groups. Event-free survival rate was 100% in T-group and 90% in Conventional group (p=.21) with a follow-up period ranging 2 to 50 months.

Conclusion: TAR plus AVR can be safely performed in patients with hypertrophied left ventricle in selected patients.