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J Thorac Cardiovasc Surg 1995;110:453-462
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

LATE ENDOTHELIAL FUNCTION OF FREE AND PEDICLED INTERNAL MAMMARY ARTERY GRAFTS

Harefield, United Kingdom

Received for publication Oct. 12, 1994. Accepted for publication Feb. 7 1995. Address for reprints: Sudhir Kushwaha, MD, MRCP, Cardiovascular Institute, The Mount Sinai Medical Center, One Gustav L. Levy Place, New York, NY 10029-6574.

Abstract

The internal mammary artery has greater long-term patency than the saphenous vein when used for coronary bypass grafting. Therefore, bilateral use of the internal mammary artery for grafting with the right internal mammary artery used as a "free" graft may result in improved graft survival. The study objectives were to compare the endothelial-dependent and -independent vasodilatory response in free and pedicled internal mammary artery grafts in patients who had previously undergone coronary surgery. Free (group 1, n = 8) and pedicled (group 2, n = 7) internal mammary artery grafts were studied by comparing the response to selective infusion of the endothelial-dependent vasodilator substance P (1.4 up to 22.4 pmol/min in doubling dose increments) followed by isosorbide dinitrate (2 mg over 2 minutes), in patients undergoing coronary angiography, 1 month to 6 years after coronary surgery. Maximal dilatory response to substance P was 8.7% ± 1.8% in pedicled grafts compared with 8.8% ± 2.3% in free grafts (p = not significant), with the dose response for both groups being similar. Infusion of isosorbide dinitrate produced only minimal further dilatation in both groups. No significant difference was found in endothelium-dependent and -independent vasodilatory response between free and pedicled internal mammary artery grafts, suggesting that the use of the free right internal mammary artery and other arterial grafts may enhance graft survival. (J THORAC CARDIOVASC SURG 1995;110:453-62)

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