Surgical Revascularization of Coronary Bifurcations Employing a Single Arterial Graft According to the "omega-Anastomosis" Technique:Initial experience.

The aim of this study was to evaluate the early postoperative outcome in patients undergoing "ω-anastomosis" construction, a technique that permits revascularization of coronary bifurcations employing a single arterial graft. Materials and methods: Between January 2000 and March 2002, ω-anastomosis was employed in 12 patients. The main indication for ω-anastomosis construction was the presence of a significant stenotic lesion involving one of the coronary tree's bifurcations, presenting a relevant secondary branch. There were ten men and two women, with a mean age of 55.4 ± 4.3 years (range 48 to 66). The ω-anastomosis was constructed employing a single arterial graft (internal mammary artery or radial artery) effectively tailored to obtain a bi-petal shape and anastomosed to the coronary bifurcation according to a three-foliate anastomosis. All patients underwent postoperative coronary angiography. Results: There were no hospital deaths, neither ECG nor enzymatic alterations. One patient was reoperated for excessive bleeding. The mean aortic cross-clamp time and duration of CPB (cardiopulmonary bypass) were 64 ± 18 minutes (range 45 to 108) and 89 ± 26 minutes (range 67 to 135), respectively. Thirty-four arterial conduits were used: 12 LIMA, 12 RIMA, and 10 RA. Twelve ω-anastomoses were constructed, in six patients employing the RA, and in six other patients employing one of the internal mammary arteries (IMAs). Five left Y-grafts between the in situ LIMA and free LIMA graft and one right Y-graft between the RIMA and RA were constructed. The mean ICU stay was 14.4 ± 5.7 hours. The postoperative coronary angiography revealed a good patency of the "ω-anastomosis. " Transthoracic color Doppler echocardiography (TTECD) demonstrated a normal IMAs flow pattern in all cases. Conclusions: We define the reported configuration as a possible surgical alternative to achieve total arterial myocardial revascularization in multi-vessels patients, associated with excellent postoperative outcome that should be part of the coronary surgical armamentarium.