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Morbidity following coronary artery revascularisation with the internal mammary artery
1Cardiothoracic Surgical Unit, Papworth Hospital, Papworth Everard, Cambridge, U.K.
Insights
Internal mammary artery grafts in coronary artery bypass grafting are linked to higher rates of chest wound pain post-discharge and chronic chest wall pain compared to vein grafts alone.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Complications
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Internal mammary artery (IMA) grafts are frequently used in CABG.
- Assessing long-term morbidity associated with graft choice is crucial.
Purpose of the Study:
- To investigate the incidence and characteristics of morbidity following CABG.
- To compare chest wound pain and chronic chest wall pain between IMA and vein grafts.
Main Methods:
- Retrospective study of 178 patients undergoing CABG.
- Minimum follow-up period of one year.
- Comparison of pain incidence based on graft type: internal mammary artery vs. vein grafts.
Main Results:
- No significant difference in in-hospital pain incidence.
- Seventy percent of patients with IMA grafts reported post-discharge chest wound pain vs. 51.7% with vein grafts (P<0.05).
- Twenty-three percent of patients with left IMA grafts experienced chronic left-sided chest wall pain vs. 4.5% with vein grafts (P<0.005).
Conclusions:
- The use of internal mammary artery grafts in CABG is associated with increased rates of post-discharge chest wound pain.
- Harvesting of left internal mammary arteries significantly increases the risk of chronic left-sided chest wall pain.
- These findings warrant careful consideration of graft selection and potential complications in coronary artery surgery.
Abstract:
To investigate the morbidity after coronary artery bypass grafting, one hundred and seventy-eight patients were retrospectively studied with a minimum follow-up period of one year. Although there was no difference in the incidence and distribution of pain in hospital, seventy percent of patients who had an internal mammary artery used as one of the bypass conduits experienced chest wound pain after discharge from hospital compared to 51.7% of patients who had vein grafts alone (P less than 0.05). Twenty-three percent of patients who had left internal mammary arteries harvested experienced chronic left-sided chest wall pain compared to 4.5% of patients who had vein grafts only (P less than 0.005). The possible factors responsible are discussed and a review made of the complications which may result from using the internal mammary artery in coronary artery surgery.