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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 73-77, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NL Mills and WL Bringaze 3d
Early reports questioned the adequacy of flow of the internal mammary
artery when used routinely as a bypass graft. "Adequate" mammary artery
flow is now contested only in certain situations, that is, left ventricular
hypertrophy, acute myocardial infarction, and reoperations. To compare the
methods of mammary pedicle graft preparations with free mammary artery
flow, we studied 31 patients who had the left internal mammary artery
harvested for elective coronary artery bypass grafting. Group I comprised
14 patients whose mean body surface area was 1.91 m2. Systolic, diastolic,
and mean arterial blood pressures, left atrial pressure, and heart rate
were recorded and stabilized during flow measurements. Free flow of the
internal mammary artery was measured before any pharmacologic manipulation
and ranged from 5 to 44 ml/min (mean 18 ml/min). The grafts were sprayed
and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40
ml normal saline) for an average of 21 minutes. Free flow ranged from 10 to
108 ml/min (mean 51 ml/min). Intraluminal papaverine of the same dilution
was then injected with hydrostatic dilatation. Immediate internal mammary
artery flows rose from 150 to 333 ml/min (mean 229 ml/min). Group II
comprised 17 patients who had internal mammary artery takedown under the
exact conditions used in group I. Mean body surface area was 1.89 m2.
Mammary artery pedicles were injected with diluted papaverine throughout
their lengths with size 25 needles. After an average of 19.5 minutes, free
flow ranged from 28 to 132 ml/min (mean 69 ml/min). Intraluminal diluted
papaverine was then administered as in group I, and flows increased from
144 to 280 ml/min (mean 198 ml/min). The distal internal mammary arteries
in both groups were 1.75 to 2.5 mm in internal diameter at the site of
arteriotomy for flow measurement. This study shows that all mammary
arteries are in spasm immediately after harvest and that flow is inadequate
before any pharmacologic intervention. Although extraluminal vasodilators
will increase free mammary artery flow, intraluminal papaverine followed by
hydrostatic dilatation raises free flow to maximal capacity. Subsequent
graft spasm has not been observed.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Preparation of the internal mammary artery graft. Which is the best method?
Department of Surgery, Cardiology Center, New Orleans, LA 70072.
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