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Myocardial revascularization using branches of the left internal mammary artery
E Tappainer1, A Fabbri, R Pessotto
1Divisione e Cattedra di Cardiochirurgia, Università di Verona, Italy.
Insights
Left internal mammary artery (LIMA) branches can be used for coronary artery bypass grafting in select patients. While LIMA branches offer symptom relief, terminal branches show significant occlusion rates, suggesting limited applicability.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
Background:
- Coronary artery disease necessitates effective revascularization strategies.
- Increasing the availability of arterial grafts is crucial for improved patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of using left internal mammary artery (LIMA) branches as bypass grafts.
- To assess the patency rates of LIMA branches in patients with multivessel coronary disease.
Main Methods:
- Utilized terminal branches of the left internal mammary artery (LIMA) for coronary artery bypass grafting in 15 patients.
- Performed "Y" grafts to the left anterior descending coronary artery territory and used pericardiophrenic branches.
- Assessed outcomes including complete myocardial revascularization, angina status, and graft patency via cardiac catheterization.
Main Results:
- Achieved complete myocardial revascularization in 33.3% of patients using only IMA grafts.
- Reported no early or late deaths, with all patients remaining angina-free at a mean follow-up of 20 months.
- Observed a 20% occlusion rate for terminal LIMA branches and a 50% occlusion rate for pericardiophrenic branches.
Conclusions:
- Terminal LIMA branches can provide symptom relief and complete revascularization in selected cases when conventional grafts are unavailable.
- The small diameter of terminal LIMA branches presents technical challenges and is associated with significant occlusion rates.
- Proximal LIMA branches exhibit higher occlusion rates and their use is not recommended.
Abstract:
To increase the number of arterial grafts in patients with multivessel coronary disease, we have used branches of the left internal mammary artery (LIMA) as bypass grafts. From March 1990 to June 1993, 15 patients (13 males and 2 females) aged 38 to 65 years (mean 57 +/- 8), received a total of 30 LIMA branch anastomoses. The two terminal branches were used to perform a "Y" graft to the left anterior descending coronary artery territory in 13 patients. A pericardiophrenic branch was used in four cases. Five patients (33.3%) had complete myocardial revascularization using IMA only. There were neither early nor late deaths and all patients are free from angina at a mean follow-up of 20 months (6 to 45 months). However, early postoperative cardiac catheterization, performed in 12 patients (80%), revealed a 20% occlusion rate for each terminal branch and a 50% occlusion rate for the pericardiophrenic branch. Technically challenging due to the small diameter of the grafts, the terminal LIMA branches should be limited to selected patients when more conventional arterial or vein conduits are not available. More proximal branches have a higher occlusion rate and their use is not recommended.