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Bovine internal thoracic artery graft for myocardial revascularization: late results
H Suma1, Y Wanibuchi, A Takeuchi
1Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
Bovine internal thoracic artery (ITA) grafts show high patency rates early after coronary artery bypass grafting but decline significantly over time, with stenosis often occurring at anastomosis sites.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafts
- Graft Patency
Background:
- Coronary artery bypass grafting (CABG) is a critical procedure for treating coronary artery disease.
- Internal thoracic artery (ITA) grafts are commonly used, but bovine ITA grafts are less studied.
- Assessing long-term patency and complications of bovine ITA grafts is essential.
Purpose of the Study:
- To evaluate the long-term patency and outcomes of bovine internal thoracic artery (ITA) grafts used in coronary artery bypass grafting.
- To identify the incidence and location of stenosis in bovine ITA grafts.
- To assess the clinical implications of bovine ITA graft performance.
Main Methods:
- A prospective study involving 29 patients undergoing CABG with bovine ITA grafts (3 mm diameter).
- Angiographic follow-up for up to 4 years in 20 patients.
- Measurement of graft blood flow using an electromagnetic flowmeter.
Main Results:
- Early patency (within 2 months) was high at 88% (14/16 grafts).
- Patency decreased to 50% (3/6 grafts) between 3 to 12 months, with 2 requiring angioplasty for stenosis.
- Late patency (after 1 year) was only 14% (1/7 grafts), with stenosis noted at anastomotic sites but not in the graft trunk.
Conclusions:
- Bovine ITA grafts demonstrate excellent initial patency but exhibit significant graft failure and anastomotic stenosis over the long term.
- The findings suggest limitations in the durability of bovine ITA grafts for coronary artery bypass grafting.
- Further research into alternative graft materials or improved surgical techniques is warranted.
Abstract:
From May 1988 to March 1990, the bovine internal thoracic artery (ITA) graft, 3 mm in diameter, was used for coronary artery bypass grafting in 29 patients with the approval of the Japanese Ministry of Health. Excluding three postoperative deaths and 6 patients who rejected postoperative angiography, 20 patients (13 men and 7 women; mean age, 62 years; range, 37 to 80 years) were followed up angiographically for up to 4 years. Sites of bovine ITA anastomosis were as follows: anterior descending, 4; circumflex, 5; and right coronary artery, 11. The mean bovine ITA graft blood flow measured by electromagnetic flowmeter was 75.2 mL/min (range, 40 to 150 mL/min). During the mean follow-up of 45 months (range, 30 to 52 months), 12 patients underwent postoperative angiography once, 6 patients twice, and 2 patients three times. It revealed 14 of 16 (88%) bovine ITA grafts were patent within 2 postoperative months. Three of 6 (50%) were patent at 3 to 12 months, of which 2 patent grafts required balloon angioplasty for distal anastomotic stenosis. In 7 patients restudied later than 1 year (20, 24, 25, 44, 48, 50, and 52 months), one of seven grafts (14%) was patent. There was stenosis (> or = 50%) at four distal and one proximal bovine ITA anastomotic sites, but no focal stenosis was found in the trunk at any period. There was one late death due to renal failure, one myocardial infarction, and one mild angina due to bovine ITA graft failure.(ABSTRACT TRUNCATED AT 250 WORDS)