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Coronary artery bypass using internal mammary artery branches
J E Morin1, G Hedderich, N L Poirier
1Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
The Annals of Thoracic Surgery
|November 1, 1992
Summary
Internal mammary artery (IMA) Y-grafts are technically feasible for coronary artery bypass surgery, but their use is not recommended due to poor long-term patency rates. Further improvements are needed to enhance graft survival.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Internal mammary artery (IMA) grafts demonstrate excellent long-term patency for left anterior descending coronary artery bypass.
- This success has driven exploration of expanded IMA utilization in coronary bypass surgery.
Purpose of the Study:
- To evaluate the efficacy and outcomes of using the two terminal branches of the IMA in a Y-configuration for coronary artery bypass grafting.
- To assess the patency rates and clinical results of IMA Y-grafts.
Main Methods:
- A cohort of 67 patients underwent coronary artery bypass grafting using IMA Y-grafts over a 6-month period.
- A total of 150 IMA branch anastomoses were performed, with objective evaluation of 60 anastomoses at follow-up.
- Clinical and electrocardiographic assessments were performed at a mean follow-up of 37 months.
Main Results:
- Operative mortality was 3%, with a 7.5% follow-up mortality.
- At a mean of 37 months, 36% of patients reported angina recurrence, and 25% had positive stress tests.
- Of the 150 IMA branch anastomoses, only 50% were patent, with 41.5% occluded and 8.5% stenotic, resulting in an overall patency rate of 58.5%.
Conclusions:
- IMA Y-grafting is a technically feasible method to increase IMA utilization.
- However, the demonstrated low patency rates do not support the extended application of this technique.
- Improved graft patency must be achieved before widespread adoption of IMA Y-grafts can be recommended.