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Triple sequential grafts using the internal mammary artery. An angiographic and short-term follow-up study
S M van Sterkenburg1, S M Ernst, A Brutel de la Rivière
1Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Sequential internal mammary artery grafts offer a feasible surgical option for coronary artery disease, demonstrating high patency rates and low perioperative risks in multiple bypass procedures.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease.
- The use of sequential arterial grafts, particularly the internal mammary artery (IMA), has evolved to improve graft longevity and revascularization.
- Optimizing surgical techniques for arterial grafting is crucial for long-term patient outcomes.
Purpose of the Study:
- To evaluate the feasibility and outcomes of multiple sequential internal mammary artery bypass grafts in patients with coronary artery disease.
- To assess the short-term and mid-term patency rates, morbidity, and mortality associated with this technique.
Main Methods:
- A retrospective analysis of 116 patients undergoing coronary artery bypass operations between 1984 and 1988.
- Inclusion of 119 sequential IMA grafts with three or more anastomoses per conduit.
- Perioperative and follow-up data collection, including angiography and clinical assessment.
Main Results:
- No hospital deaths occurred; perioperative infarction rate was 3.4%.
- Overall graft patency was 94.6%, with sequential IMA grafts (≥3 anastomoses) achieving 96.1% patency.
- At a mean follow-up of 13 months, 97.4% of patients were in New York Heart Association class I, with a late myocardial infarction rate of 2.6%.
Conclusions:
- Multiple sequential internal mammary artery bypass grafts are a feasible surgical strategy for coronary artery disease.
- This technique demonstrates high short-term graft patency and favorable perioperative morbidity and mortality.
- Sequential IMA grafting represents an effective approach for arterial revascularization in selected patients.
Abstract:
Between December 1984 and December 1988, coronary artery bypass operations, involving the use of 119 sequential internal mammary artery grafts with three or more anastomoses per conduit, were performed in 116 patients. Patients included 14 women and 102 men, with a mean age of 60 years. They received a total of 629 anastomoses; 373 anastomoses were used in multiple sequential arterial bypass grafts; 116 sequential left and three right internal mammary artery jump grafts were performed. There were 27 patients with bilateral internal mammary artery grafts, but only 17 had completely arterial revascularizations. Perioperative infarction occurred in 3.4% of the patients; 1.7% of infarctions were related to sequential internal mammary artery grafts. There were no hospital deaths. Control angiography was performed within a month of the operation in 72 patients (with 371 anastomoses, of which 229 were in sequential arterial bypass grafts). The overall patency rate was 94.6%, and for the internal mammary artery sequential graft with three or more anastomoses it was 96.1%. The mean follow-up period was 13 months; 110 patients were in New York Heart Association class I; there was one non-cardiac-related death, and three patients (2.6%) had a late myocardial infarction. One was related to the area revascularized by the sequential internal mammary artery graft. Multiple sequential internal mammary artery bypass grafts in coronary artery disease are feasible, with a high short-term patency and a low perioperative morbidity and mortality.