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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 832-846, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JS Rankin, GE Newman, TM Bashore, LH Muhlbaier, GS Tyson Jr, TB Ferguson Jr, JG Reves and DC Sabiston Jr
The internal mammary artery has become the coronary bypass graft of choice
in recent years because of enhanced long-term patency. Along with this
trend, sequential, bilateral, and free mammary grafts have been employed
more frequently in an effort to maximize the number of distal internal
mammary anastomoses. This approach of maximally using the internal mammary
artery (complex mammary grafting) seems logical, but at present little
information about patency of the newer types of internal mammary artery
grafts is available to justify the more complicated procedures. Over a 15
month period, 207 patients underwent bypass graft angiography from 1 to 32
weeks after operation. This is an 85% restudy rate for a consecutive series
of coronary bypass procedures. Patency was defined as complete filling of
the graft and distal vessel bypassed. A total of 841 distal vessels were
grafted, or 4.1 per patient. The overall patency rate was 91% for 503
distal vein graft anastomoses and 99% for 338 internal mammary artery
grafts. Individual patency rates of distal anastomoses, expressed as number
patent/total (percent patent), were as follows: simple vein grafts, 262/285
(92%); sequential vein grafts, 196/218 (90%); left internal mammary artery
to left anterior descending coronary artery, 109/110 (99%); left internal
mammary to circumflex marginal artery, 14/14 (100%); right internal mammary
to right coronary artery, 19/20 (95%); right internal mammary to left
anterior descending coronary artery, 10/10 (100%); right internal mammary
to circumflex marginal artery via transverse sinus, 18/20 (90%); sequential
left internal mammary artery to left anterior descending system, 133/134
(99%); sequential left internal mammary to circumflex marginal system,
15/15 (100%); free internal mammary artery, 9/9 (100%); free sequential
internal mammary artery, 6/6 (100%). Of the 18 patent transverse sinus
right internal mammary grafts to the circumflex marginal artery, three
exhibited very slow flow and probably were not functional. The hospital
mortality associated with internal mammary revascularizations was 0.4% for
nonemergency cases and 3.1% for emergency procedures. On the basis of
clinical and postoperative graft patency data, expanded use of more
complicated types of mammary grafts seems justified. Function of the right
internal mammary graft to the circumflex marginal artery was suboptimal,
and this method has been discontinued. All other complex mammary techniques
had excellent patency rates as compared to vein grafts, and these
differences may become even more significant in the late postoperative
period.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Clinical and angiographic assessment of complex mammary artery bypass grafting
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