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J Thorac Cardiovasc Surg 1998;116:668
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Reply

Gregor Zünd, MD, Paul Vogt, MD, Marko Türina, MD

Zurich, Switzerland

Clinic for Cardiovascular Surgery, University Hospital Zurich, Ramistrasse 100, CH-8091 Zurich, Switzerland

Reply to the Editor:

The left internal thoracic artery (LITA) has become the conduit of choice for myocardial revascularization, because it has been proved that early mortality and morbidity are low.Go Go 1-3 At our institution 98% of all surgical revascularizations of the myocardium are performed with an LITA on the left anterior descending artery (LAD). Perioperative or early postoperative malperfusion of the LITA is a rare complication of coronary artery bypass grafting and may lead to the potentially fatal LITA hypoperfusion syndrome, which is caused by an acute imbalance between myocardial demand and nutritional support through the LITA.Go Go 4-6 Since we changed the preparation technique of the LITA by using very-low electrocautery and dilatation of the LITA by intraluminal infusion of 1% papaverine solution, the incidence of LITA hypoperfusion syndrome has decreased significantly to 1% in 1997. Recently Pagni and associatesGo 7 demonstrated on a dog model that the increased distance (3-4 cm) of the additional vein graft implantation to the LITA might be an important factor in maintaining ITA patency. The additional vein graft implantation described in our article was at least 3 cm distal to the LITA implantation performed.

Still, and as we do agree with Galea and associates, the additional vein graft to the LAD is the therapy of choice for LITA hypoperfusion syndrome.

References

  1. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal mammary artery for coronary artery bypass. J Thorac Cardiovasc Surg 1995;90:668-75. [Abstract]
  2. Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 1985;89:248-58. [Abstract]
  3. Cameron A, Davis KP, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic artery grafts effects on survival over a 15-year period. N Engl J Med 1996;25;334:216-9.
  4. Vajtai P, Raviachandran PS, Fessler CL, Floten HS, Ahmad A, Gately HL, et al. Inadequate internal mammary artery graft as a cause of postoperative ischemia: incidence, diagnosis and management. Eur J Cardiothorac Surg 1992;6:603-8. [Abstract]
  5. Sarabu MR, McClung JA, Fass A, Reed GE. Early postoperative spasm in left internal mammary artery bypass grafts. Ann Thorac Surg 1987;44:199-200. [Abstract]
  6. Segesser LV, Simonet F, Meier B, Finci L, Faidutti B. Inadequate flow after internal mammary coronary artery anastomosis. Thorac Cardiovasc Surg 1987;35:352-5. [Medline]
  7. Pagni S, Salloum E, Storey J, Montgomery W, Cerrito P, Van Himbergen D, et al. Double grafting of the left anterior descending artery: Is the distance between the interal mammary artery and supplemental vein graft anastomoses relevant in graft survival? Eur J Cardiothorac Surg 1998;13:36-41. [Abstract/Free Full Text]



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This Article
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