Treatment of Complex Two-Vessel Coronary Heart Disease with Single Left Internal Mammary Artery as T-Graft with Itself—A Retrospective Double Center Analysis of Short-Term Outcomes
Christian Jörg Rustenbach,
Ilija Djordjevic,
Kaveh Eghbalzadeh,
Hardy Baumbach,
Stefanie Wendt,
Medhat Radwan,
Spiro Lukas Marinos,
Migdat Mustafi,
Mario Lescan,
Rafal Berger,
Christoph Salewski,
Rodrigo Sandoval Boburg,
Volker Steger,
Attila Nemeth,
Stefan Reichert,
Thorsten Wahlers,
Christian Schlensak
Affiliations
Christian Jörg Rustenbach
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Ilija Djordjevic
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
Kaveh Eghbalzadeh
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
Hardy Baumbach
Kardion GmbH, 70376 Stuttgart, Germany
Stefanie Wendt
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
Medhat Radwan
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Spiro Lukas Marinos
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Migdat Mustafi
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Mario Lescan
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Rafal Berger
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Christoph Salewski
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Rodrigo Sandoval Boburg
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Volker Steger
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Attila Nemeth
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Stefan Reichert
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Thorsten Wahlers
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Cologne, Germany
Christian Schlensak
Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, University of Tuebingen, 72076 Tübingen, Germany
Background and Objectives: The strategy of revascularization may be constrained in patients with insufficient bypass grafts and with increased risk of wound healing disorders. Among those with complex left-sided double-vessel disease in whom a percutaneous coronary intervention (PCI), as well as the surgical procedure of minimally invasive coronary artery bypass grafting via left minithoracotomy (MICS CABG), is not a treatment option, CABG using the left internal mammary artery as a T-graft with itself may be an effective treatment strategy. Materials and Methods: We reviewed the data from patients treated in Cologne and Tuebingen from 2019 to 2022. We included 40 patients who received left internal mammary artery (LIMA) grafting, and additional T-graft with the LIMA itself. The objective was focused on intraoperative and short-term outcomes. Results: A total of 40 patients were treated with the LIMA-LIMA T-graft procedure with a Fowler score calculated at 20.1 ± 3.0. A total of 37.5% of all patients had lacking venous graft material due to prior vein stripping, and 21 patients presented severe vein varicosis. An overall of 2.6 ± 0.5 distal anastomoses (target vessels were left anterior descending, diagonal, intermediate branch, and/or left marginal ramus) were performed, partly sequentially. Mean flow of LIMA-Left anterior descending (LAD) anastomosis was 59.31 ± 11.04 mL/min with a mean PI of 1.21 ± 0.18. Mean flow of subsequent T-Graft accounted for 51.31 ± 3.81 mL/min with a mean PI of 1.39 ± 0.47. Median hospital stay was 6.2 (5.0; 7.5) days. No incidence of postoperative wound healing disorders was observed, and all patients were discharged. There was one 30-day readmission with a diagnosis of pericardial effusion (2.5%). There was no 30-day mortality within the cohort. Conclusions: Patients requiring surgical myocardial revascularization due to complex two-vessel coronary artery disease (CAD) can be easily managed with LIMA alone, despite an elevated Fowler score and a promising outcome. A prospective study needs to be conducted, as well as longer term surveillance, to substantiate and benchmark the long-term results, as well as the patency rates.
