[Using the internal thoracic artery of patients with reduced left ventricular function]

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Vascular Grafting

Background:

• Internal mammary artery (IMA) use in coronary artery bypass grafting (CABG) is debated for patients with poor left ventricular function (LVEF < 40%).
• Concerns include increased operation time, lower initial blood flow, and higher reoperation rates for bleeding.

Purpose of the Study:

• To compare the safety and efficacy of routine IMA grafting versus exclusive vein grafting in patients with reduced LVEF.
• To evaluate outcomes such as operation time, bleeding, hemodynamic stability, and mortality.

Main Methods:

• A randomized study of 137 patients with coronary artery disease and LVEF < 40%.
• Group I (67 patients) received exclusively vein grafts; Group II (70 patients) received routine IMA grafts.
• Outcomes assessed included operation time, postoperative bleeding, need for catecholamines, intensive care unit stay, perioperative myocardial infarction, and mortality.

Main Results:

• Operation times were similar between groups.
• Group II (IMA) had significantly higher postoperative bleeding (905 ml) compared to Group I (569 ml) (p < 0.05).
• Cardiac low output syndrome was significantly lower in the IMA group (2.9%) versus the vein graft group (13.5%) (p < 0.05).
• No significant differences were found in catecholamine use, hemodynamic parameters, intensive care duration, ventilation time, perioperative myocardial infarction, or mortality.

Conclusions:

• Patients with poor left ventricular function face higher risks during bypass surgery.
• Routine IMA grafting showed no disadvantages compared to vein grafting, except for increased perioperative bleeding.
• IMA grafting is recommended for patients with poor left ventricular function due to potentially better long-term results.