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Revascularization with bilateral internal thoracic artery grafts in patients with left main coronary stenosis
H B Barner1, K S Naunheim, V L Willman
1Department of Surgery, St. Louis University Medical Center, Mo.
Insights
Bilateral internal thoracic artery (ITA) grafts effectively revascularized left main occlusive disease (LMD) without perioperative deaths. This study demonstrates ITA
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Left main occlusive disease (LMD) is a critical condition requiring surgical revascularization.
- Internal thoracic artery (ITA) grafts offer superior long-term patency but face concerns about flow limitation.
- High graft flows are desirable in LMD patients, potentially limiting sole ITA use.
Purpose of the Study:
- To evaluate the efficacy and safety of using bilateral ITA grafts for revascularization in patients with LMD.
- To assess graft flow rates and perioperative outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 45 LMD patients undergoing revascularization from 1985 to 1990.
- Utilized bilateral ITA grafts for left anterior descending and circumflex arteries.
- Right ITA used as a free graft in 42% of cases; left ITA as free graft in 7%.
Main Results:
- No perioperative deaths occurred in the 45 patients.
- Morbidity included myocardial infarction, stroke, and reoperation for bleeding (2.2% each).
- Intra-operative ITA graft flows averaged 49.7 ml/min (LAD) and 45.5 ml/min (circumflex).
Conclusions:
- Bilateral ITA grafting is a safe and effective strategy for LMD revascularization.
- This approach avoids saphenous vein grafts to the left coronary system, leveraging ITA's patency.
- The study supports the use of bilateral ITA grafts even when high flow is desired.
Abstract:
Left main occlusive disease (LMD) is a potentially fatal lesion which is optimally treated with surgical revascularization. Although the internal thoracic artery (ITA) is recognized as having superior long term patency, there has been concern regarding possible flow limitation. Because of this concern, there may be reluctance to use only this conduit in patients with LMD in whom high graft flows are desirable. From 1985 to 1990, 45 patients (38 males, 7 females) with LMD ranging in age from 37 to 75 years (mean 55.9 +/- 8.7) underwent revascularization using bilateral ITA grafts placed to the left anterior descending and circumflex arteries. The right ITA was used as a free graft in 19 of 45 (42%) patients and the left ITA was used as a free graft in 3 of 35 (7%). No saphenous vein grafts were placed to the left coronary system in any patient. Over half of these patients (24 patients, 53%) also had occlusive disease in the right coronary artery. A saphenous vein graft was placed to the right coronary artery in 22 of 45 (49%) patients. Ventricular function in this patient subset was good (mean LV score 7.1 +/- 2.1). Intra-operative ITA graft flows were 49.7 +/- 29.1 ml/min for grafts to the left anterior descending and 45.5 +/- 31.7 ml/min for circumflex grafts. There were no perioperative deaths. Morbidity included myocardial infarction, stroke and reoperation for bleeding in 1 patient each (2.2%). Low cardiac output occurred in 2 patients (4.4%). No patient had a mediastinal wound infection.(ABSTRACT TRUNCATED AT 250 WORDS)