Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (5): 12-17.doi: 10.6040/j.issn.1671-7554.0.2024.0771

• Special Topic on Application of Arterial Grafts in Coronary Artery Bypass Grafting • Previous Articles     Next Articles

Anatomic complete revascularization is a new strategy of surgical treatment for coronary heart disease

CHEN Xujun1, SHEN Lin2, CHEN Jun3, YU Tao4, CAO Guangqing5, XIAO Fei6   

  1. 1. Department of Cardiac Surgery, Wuhan First Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China;
    2. Department of Cardio-Thoracic Surgery, The Second Affiliated Hospital of Chonging Medical University, Chongqing 401336, China;
    3. Department of Cardiac Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China;
    4. Cardiac Surgery Center, Sichuan Provincial Peoples Hospital, Chengdu 610072, Sichuan, China;
    5. Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    6. Department of Cardiac Surgery, Guangdong Provincial Peoples Hospital, Guangzhou 510080, Guangdong, China
  • Published:2025-05-07

PDF (PC)

147

Abstract: Complete revascularization(CR)has received increasing attention in coronary artery bypass grafting(CABG)and is categorized as anatomic complete revascularization(ACR)and functional complete revascularization(FCR). Multiple clinical trials validated that CR was associated with improved mid-term and long-term clinical outcomes in CABG. A recent randomized controlled multicenter trial(ISCHEMIA study)showed that both ACR and FCR in CABG led to improved angina-related health status and life quality, reduced incidence of cardiac death and myocardial infarction, and improved mid-term and long-term outcomes compared with incomplete revascularization and conservative management in patients with stable ischemic heart disease, more pronounced with ACR than FCR. Although there are urgent problems to be solved, ACR, as a new surgical strategy, might offer a new perspective for improving safety and efficacy of CABG and promise to be widely used in total arterial CABG, surgical treatment of chronic ischemic cardiomyopathy, and hybrid coronary revascularization.

Key words: Coronary heart disease, Coronary artery bypass grafting, Complete revascularization, Anatomic complete revascularization

CLC Number: 

  • R654
[1] Gaba P, Gersh BJ, Ali ZA, et al. Complete versus incomplete coronary revascularization: definitions, assessment and outcomes[J]. Nat Rev Cardiol, 2021, 18(3): 155-168.
[2] Ali ZA, Horst J, Gaba P, et al. Standardizing the definition and analysis methodology for complete coronary artery revascularization[J]. J Am Heart Assoc, 2021, 10(9): e020110. doi: 10.1161/JAHA.120.020110
[3] Belyayev L, Stock EM, Hattler B, et al. Complete coronary revascularization and outcomes in patients who underwent coronary artery bypass grafting: insights from the REGROUP trial[J]. Am J Cardiol, 2024, 217: 127-135. doi:10.1016/j.amjcard.2024.01.015
[4] Shintomi S, Saito S, Hamasaki A, et al. Propensity score-matched comparison of total arterial off- and on-pump coronary artery bypass with complete revascularization[J]. Heart Vessels, 2024, 39(2): 175-184.
[5] Aboul-Hassan SS, Awad AK, Stankowski T, et al. Impact of incomplete revascularization on long-term survival based on revascularization strategy[J]. Ann Thorac Surg, 2024, 118(3): 605-614.
[6] Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J, 2019, 40(2): 87-165.
[7] Bianco V, Kilic A, Aranda-Michel E, et al. Complete revascularization during coronary artery bypass grafting is associated with reduced major adverse events[J]. J Thorac Cardiovasc Surg, 2023, 166(1): 104-113.
[8] Schaefer A, Conradi L, Schneeberger Y, et al. Clinical outcomes of complete versus incomplete revascularization in patients treated with coronary artery bypass grafting: insights from the TiCAB trial[J]. Eur J Cardiothorac Surg, 2020: ezaa330. doi:10.1093/ejcts/ezaa330
[9] Diegeler A, Börgermann J, Kappert U, et al. Five-year outcome after off-pump or on-pump coronary artery bypass grafting in elderly patients[J]. Circulation, 2019, 139(16): 1865-1871.
[10] Sohn SH, Kang Y, Kim JS, et al. Impact of functional vs anatomic complete revascularization in coronary artery bypass grafting[J]. Ann Thorac Surg, 2023, 115(4): 905-912.
[11] Sakata T, De La Pena C, Ohira S. Functional or anato-mical completeness of revascularization after coronary artery bypass grafting[J]. Ann Thorac Surg, 2023, 116(4): 862.
[12] Group ITR, Maron DJ, Hochman JS, et al. International study of comparative health effectiveness with medical and invasive approaches(ISCHEMIA)trial: rationale and design[J]. Am Heart J, 2018, 201: 124-135. doi:10.1016/j.ahj.2018.04.011
[13] Mavromatis K, Jones PG, Ali ZA, et al. Complete revascularization and angina-related health status in the ISCHEMIA trial[J]. J Am Coll Cardiol, 2023, 82(4): 295-313.
[14] Stone GW, Ali ZA, O’Brien SM, et al. Impact of complete revascularization in the ISCHEMIA trial[J]. J Am Coll Cardiol, 2023, 82(12): 1175-1188.
[15] Mehaffey JH, Hawkins RB. Commentary: At the surgeon’s discretion: complete revascularization is best[J]. J Thorac Cardiovasc Surg, 2023, 166(1): 118-119.
[16] Dimitriadis K, Pyrpyris N, Tsioufis K. Functional vs anatomical complete revascularization: is there an “ISCHEMIA” of FFR?[J]. J Am Coll Cardiol, 2024, 83(4): e35. doi:10.1016/j.jacc.2023.10.048
[17] Ren J, Royse C, Tian DH, et al. Survival of multiple arterial grafting in diabetic populations: a 20-year national experience[J]. Eur J Cardiothorac Surg, 2023, 63(6): ezad091. doi:10.1093/ejcts/ezad091
[18] Rocha RV, Tam DY, Karkhanis R, et al. Long-term outcomes associated with total arterial revascularization vs non-total arterial revascularization[J]. JAMA Cardiol, 2020, 5(5): 507-514.
[19] Taggart DP, Gaudino MF, Gerry S, et al. Effect of total arterial grafting in the Arterial Revascularization Trial[J]. J Thorac Cardiovasc Surg, 2022, 163(3): 1002-1009.
[20] Sabik JF 3rd, Mehaffey JH, Badhwar V, et al. Multiarterial vs single-arterial coronary surgery: 10-year follow-up of 1 million patients[J]. Ann Thorac Surg, 2024, 117(4): 780-788.
[21] Gaudino M, Puskas JD, Di Franco A, et al. Three ar-terial grafts improve late survival: a meta-analysis of propensity-matched studies[J]. Circulation, 2017, 135(11): 1036-1044.
[22] Ren J, Tian DH, Gaudino M, et al. Survival benefit of multiple arterial revascularization with and without supp-lementary saphenous vein graft[J]. J Am Heart Assoc, 2023, 12(22): e031986. doi:10.1161/JAHA.123.031986
[23] Gaudino MFL, Sandner S, Bonalumi G, et al. How to build a multi-arterial coronary artery bypass programme: a stepwise approach[J]. Eur J Cardiothorac Surg, 2020, 58(6): 1111-1117.
[24] Velazquez EJ, Lee KL, Jones RH, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy[J]. N Engl J Med, 2016, 374(16): 1511-1520.
[25] Bakaeen FG, Gaudino M, Whitman G, et al. 2021: the American Association for Thoracic Surgery Expert Consensus Document: coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure[J]. J Thorac Cardiovasc Surg, 2021, 162(3): 829-850.
[26] Iacona GM, Bakhos JJ, Tong MZ, et al. Coronary artery bypass grafting in left ventricular dysfunction: when and how[J]. Curr Opin Cardiol, 2023, 38(6): 464-470.
[27] 刘达兴, 陈绪军, 郑宝石, 等. 体外循环下全动脉冠状动脉旁路移植治疗左室功能低下冠心病多中心临床观察[J]. 中华医学杂志, 2020, 100(18): 1390-1395. LIU Daxing, CHEN Xujun, ZHENG Baoshi, et al. On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: a multi-center retrospective study[J]. National Medical Journal of China, 2020, 100(18): 1390-1395.
[28] Nakae M, Kainuma S, Toda K, et al. Impact of complete revascularization in coronary artery bypass grafting for ischemic cardiomyopathy[J]. JTCVS Open, 2023, 15: 211-219. doi:10.1016/j.xjon.2023.04.008
[29] Fang HY, Fang YN, Chen YC, et al. The impact of complete revascularization in symptomatic severe left ventricular dysfunction between coronary artery bypass graft and percutaneous coronary intervention[J]. Cardiol Res Pract, 2023, 2023: 9226722. doi:10.1155/2023/9226722
[30] Fremes SE, Marquis-Gravel G, Gaudino MFL, et al. STICH3C: rationale and study protocol[J]. Circ Cardiovasc Interv, 2023, 16(8): e012527. doi:10.1161/CIRCINTERVENTIONS.122.012527
[31] Mavioglu I. Minimally invasive off-pump anaortic complete arterial coronary artery bypass: how to do it?[J]. Innovations, 2023, 18(4): 376-379.
[32] Stähli BE, Varbella F, Linke A, et al. Timing of complete revascularization with multivessel PCI for myocardial infarction[J]. N Engl J Med, 2023, 389(15): 1368-1379.
[33] Guyton RA, Halkos ME. Benefit of complete anatomic revascularization in ISCHEMIA: reprise of a familiar theme[J]. J Am Coll Cardiol, 2024, 83(4): e37. doi:10.1016/j.jacc.2023.10.047
[34] 陈绪军, 张建, 李伟栋, 等. 2023 年欧洲心胸外科协会和美国胸外科医师协会《冠状动脉旁路移植术旁路血管选择专家共识》解读[J]. 中华外科杂志, 2024, 62(1): 44-48. CHEN Xujun, ZHANG Jian, LI Weidong, et al. Interpretation on Expert systematic review on the choice of conduits for coronary artery bypass grafting endorsed by the European Association for Cardio Thoracic Surgery and the Society of Thoracic Surgeons in 2023[J]. Chinese Journal of Surgery, 2024, 62(1): 44-48.
[35] Kaya IC, Bulut HI, Candelario K, et al. Complete surgical revascularization after NSTEMI and unstable angina in patients with multivessel coronary artery disease: institutional experience[J]. Asian Cardiovasc Thorac Ann, 2023, 31(8): 675-681.
[1] GUO Ke, CHEN Xujun, SHI Chao, LUO Junhui, YANG Min, WANG Xiaowu, WANG Zhendong, LI Youjin, MENG Chunying, CHEN Wensheng. Outcomes of a Y-composite arterial graft using free right internal mammary artery and radial artery for patients undergoing total arterialization myocardial revascularization in multi-center in China [J]. Journal of Shandong University (Health Sciences), 2025, 63(9): 84-91.
[2] CHEN Xujun, HE Guowei. Focus on further more use of arterial grafts in coronary artery bypass grafting in patients with coronary heart disease in China [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 1-5.
[3] XIAO Fei, WANG Lianqun, JI Qiang. Application interpretation of STS multi-vessel coronary artery bypass grafting [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 6-11.
[4] GUO Ke, CHEN Xujun, ZHENG Baoshi, HUANG Keli, WANG Xiaowu, CHEN Jingwei, LIN Yu, LUO Junhui, WANG Haichen, WANG Zhendong, LIAO Chengquan, LI Youjin, CHEN Wensheng. Multi-center mid-term clinical outcomes in coronary patients undergoing total arterial bypass surgery with anatomic complete revascularization in China [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 18-25.
[5] GUO Ke, CHEN Xujun, ZHENG Baoshi, SHI Chao, HUANG Keli, CAO Yong, CHEN Jun, WU Dongkai, ZHANG Xiaoshen, LUO Junhui, SHEN Lin, MO Xumin, YANG Min, WANG Xiaowu, LEI Yinsheng, TIAN Maozhou, WANG Zhendong, MENG Zili, SUN Zhongdong, LI Youjin, LU Huihui, MENG Chunying, GAO Feng, CHEN Qiansu, GUO Nengrui, LIU Debin, ZHANG Nan, LIN Yu, CHEN Wensheng, SONG Baoguo, FANG Zhi, WANG Haichen, LIAO Xiaobo, XU Chaojun. Multi-center clinical outcomes of fast-track extubation in total arterial coronary bypass grafting in China [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 26-32.
[6] LU Shengxun, XING Yachuang, LUO Junhui, LIU Jie, HE Houle, WANG Zhiqiang, ZHANG Na. Diabetic patients arterial grafts in coronary artery bypass grafting: current research status [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 33-39.
[7] MO Xuming, WANG Qingfeng. Application of coronary artery bypass grafting in pediatric cardiovascular disease [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 40-46.
[8] WANG Zhiqi, QI Jirong, HU Yuanli, CHEN Xujun, WANG Qingfeng, MO Xuming. Total arterial coronary artery bypass grafting for treatment of coronary artery aneurysm after Kawasaki disease in a child: case report and literature review [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 47-53.
[9] WEN Xuelong, LIU Anhui, CHEN Jingwei, WU Mengting, YANG Min. A Meta-analysis of the timing of coronary artery bypass grafting surgery for acute non-ST myocardial infarction [J]. Journal of Shandong University (Health Sciences), 2025, 63(5): 60-70.
[10] YANG Huimin, GONG Wanli, HOU Yaqi, WU Jing, WANG Yang, HE Peifeng, YU Qi. Causal association between 20 amino acids and coronary heart disease: a Mendelian randomization study [J]. Journal of Shandong University (Health Sciences), 2025, 63(12): 6-16.
[11] ZHANG Xiwei, REN Linwei, ZHANG Hui, ZHANG Xinjie, LIU Weiguo, WANG Dong. Early clinical efficacy of left internal thoracic artery plus radial artery in total arterialized coronary artery bypass grafting [J]. Journal of Shandong University (Health Sciences), 2024, 62(3): 39-46.
[12] HAN Chuang, CHENG Chuanlong, LI Chunyu, LIU Ying, FANG Qidi, CUI Feng, YANG Shuxia, HAN Peng, LI Xiujun. Short-term effects of diurnal temperature range on hospital admissions for coronary heart disease in Zibo City [J]. Journal of Shandong University (Health Sciences), 2023, 61(4): 111-118.
[13] XIE Jiaying, QI Jia, SONG Ming, LI Yulin, WANG Di, JIA Xu, ZHANG Wei, ZHONG Ming, SHANG Yuanyuan. Association between serum β-sheet level and coronary heart disease [J]. Journal of Shandong University (Health Sciences), 2022, 60(1): 21-26.
[14] LIU Congcong, CHEN Xiaolu, SI Shucheng, WANG Bojie, LI Yunxia, LI Wenchao, YUAN Tonghui, XUE Fuzhong. Association between serum uric acid variability and risk of coronary heart disease in Shandong Province [J]. Journal of Shandong University (Health Sciences), 2020, 58(12): 109-116.
[15] LI Mingzhuo, SUN Xiubin, WANG Chunxia, YANG Yang, LIU Xinhui, LIU Yanxun, XUE Fuzhong, YUAN Zhongshang. Association between longitudinal changes of HDL-C and coronary heart disease in a population with normal serum lipids: a retrospective cohort study [J]. Journal of Shandong University (Health Sciences), 2019, 57(8): 110-116.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd