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Sequential internal mammary artery grafts: clinical and angiographic assessment
1Department of Thoracic and Cardiovascular Surgery, St Mary's Hospital, Kurume, Japan.
Insights
Sequential internal mammary artery grafts show high patency rates but risk the
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Disease
Background:
- The internal mammary artery is a common arterial graft in coronary artery bypass grafting.
- Sequential grafting involves using a single graft to connect multiple coronary arteries.
Purpose of the Study:
- To evaluate the efficacy and outcomes of sequential internal mammary artery grafting to the left anterior descending artery and diagonal branches.
- To identify potential complications and limitations of this surgical technique.
Main Methods:
- Retrospective analysis of 34 patients undergoing sequential internal mammary artery grafting between January 1988 and August 1992.
- Postoperative follow-up included clinical assessment for angina and cardiac catheterization within 1 year.
Main Results:
- One in-hospital mortality (3%).
- All surviving patients remained angina-free for up to 4 years.
- 98% of anastomoses (65/66) were patent on angiography.
- A 'string sign' was observed in 5% (3/65) of patent grafts between sequential anastomoses.
Conclusions:
- Sequential internal mammary artery grafting demonstrates excellent short-term patency and angina relief.
- The 'string sign' is a potential complication that requires prevention.
- This technique may be best suited for coronary arteries with severe stenosis bifurcating into two targets.
Abstract:
Between January 1988 and August 1992, the internal mammary artery was used as a sequential graft to the left anterior descending artery and/or diagonal branch in 34 patients. One patient died in hospital. After surgery all survivors were free from angina for a follow-up of up to 4 years. Recatheterization was performed in 33 patients within 1 year of surgery. Postoperative angiography showed that 65 anastomoses (98%) were patent, but three patent grafts (5%) between the proximal and distal sequential anastomoses showed 'string sign'. It is important to prevent 'string sign' in sequential grafting. It is considered that sequential internal mammary artery grafting should be limited to coronary arteries with severe stenosis that divides anastomosed coronary arteries into two.