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Abstract/Summary
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<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Objective</jats:title>
<jats:p>The effect of one-inflow and two-inflow coronary surgical revascularization techniques inclosing skeletonized double mammary artery (BIMA) as T-graft on outcome is studied.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Early ad mid-term outcome of complete BIMA revascularization (C-T-BIMA) versus left-sided BIMA with right-sided aorto-coronary bypass (L-T-BIMA + R-CABG) is quantified and analyzed by multivariate logistic regression, Cox-regression, and Kaplan–Meier analysis in a series of 204 consecutive patients treated for triple-vessel coronary disease (3v-CAD).</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>The L-T-BIMA + R-CABG technique (<jats:italic>n</jats:italic> = 104) enables higher number of total (4.02 ± 0.87 vs. 3.71 ± 0.69, <jats:italic>p</jats:italic> = 0.015) and right-sided (1.21 ± 0.43 vs. 1.02 ± 0.32, <jats:italic>p</jats:italic> = 0.001) coronary anastomoses, improves total bypass flow (125.88 ± 92.41 vs. 82.50 ± 49.26 ml, <jats:italic>p</jats:italic> < 0.0001) and bypass flow/anastomosis (31.83 ± 23.9 vs.22.77 ± 14.23, <jats:italic>p</jats:italic> = 0.001), and enhances completeness of revascularization (84% vs.69%, <jats:italic>p</jats:italic> = 0.014) compared to C-T-BIMA strategy (<jats:italic>n</jats:italic> = 100), respectively.</jats:p>
<jats:p>Although the incidence of MACCE was comparable in the two groups (8% vs.1.2%, <jats:italic>p</jats:italic> = 0.055), the progression of functional mitral regurgitation (FMR) was significantly lower after L-T-BIMA + R-CABG, then after C-T-BIMA (47% vs.64%, <jats:italic>p</jats:italic> = 0.017).</jats:p>
<jats:p>The use of C-T-BIMA-technique (HR = 4.2, <jats:italic>p</jats:italic> = 0.01) and preoperative RCA occlusion (HR = 3.006, <jats:italic>p</jats:italic> = 0.023) predicted FMR progression, whereas L-T-Graft + R-CABG technique protected against it (X<jats:sup>2</jats:sup> = 14.04, <jats:italic>p</jats:italic> < 0.0001) independent of the anatomic and clinical complexity (Syntax score I: HR = 16.2, <jats:italic>p</jats:italic> = 0.156, Syntax score II: HR = 1.901, <jats:italic>p</jats:italic> = 0.751), of early- (0.96% vs.2%, <jats:italic>p</jats:italic> = 0.617) and mid-term mortality (5.8% vs.4%, <jats:italic>p</jats:italic> = 0.748) when compared to C-T-BIMA, respectively.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>The two-inflow coronary revascularization by L-T-BIMA + R-CABG better protects against FMR progression without increasing MACCE and mortality. Older patients with RCA occlusion and reduced LV-EF benefit most from the two-inflow L-T-BIMA + R-CABG technique. Younger 3v-CAD patients with normal LV-EF can preferentially be managed with the one-inflow C-T-BIMA; however, long-term outcome remains to be revealed.</jats:p>
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