In Situ Skeletonized Right Internal Mammary Artery Bypass Grafting to Left Anterior Descending Artery

Abstract

SummaryThis study aimed to evaluate the feasibility and the mid-term efficacy of an in situ skeletonized right internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD), and to determine risk factors for IMA graft failure in a single-center study.From January 2012 to December 2015, 189 patients (173 males, 50.6 ± 6.0 years old) undergoing first isolated coronary artery bypass grafting surgery with the in situ skeletonized right IMA grafting to the LAD were included in this study. Baseline characteristics, peroperative data, and follow-up outcomes were investigated and analyzed.The length of the in situ skeletonized right IMA grafts was 18.6 ± 1.2 cm (17.0-22.0 cm). Intraoperative graft flow of the in situ skeletonized right IMA grafting to LAD was 42 ± 9 mL/minute (18-72 mL/minute) associated with measured pulsatility index of 0.8-4.3. In-hospital mortality was 0.5%. Postoperative morbidity included acute myocardial infarction (0.5%), stroke (0.5%), and deep sternal wound infections (1.1%). The midterm survival was 97.2% and the incidence of repeat revascularization was 0.6%. The patency rate of the in situ skeletonized right IMA grafting to the LAD was 97.1% by computed tomography angiography examination during the follow-up period of 23.2 ± 9.7 months. Additionally, logistic regression analysis showed that intraoperative graft flow had an independent influence on the risk of the mid-term right IMA graft failure.The strategy of the in situ skeletonized right IMA grafting to the LAD is feasible and effective. Intraoperative graft flow was an independent risk factor for the mid-term right IMA graft failure.(Int Heart J 2018; 59: 35-42) Key words: Coronary artery bypass grafting, Artery skeletonization, Intraoperative graft flow, Graft patency C oronary artery bypass grafting surgery (CABG) remains one of the most common cardiac surgical procedures today. [1][2][3][4][5] It has been demonstrated to provide symptomatic relief and increase the long-term survival for patients with coronary artery disease, which is mainly attributed to a complete revascularization and a left internal mammary artery (IMA) bypass grafting to a left anterior descending artery (LAD). [1][2][3][4][5] Following the publication of the landmark study by Loop in 1986, which validated positive impacts of the IMA graft on 10-year survival and other cardiac events, the strategy of the left IMA grafting to the LAD is considered as the "gold standard" of coronary revascularization.6) Given the fact that patients who received CABG surgery often require more than one graft, the prospect of bilateral IMA grafting becomes very appealing to cardiac surgeons after recognition of the long-term benefits of left IMA graft. 7)However, the use of bilateral IMA grafting is scarcely diffused. 8,9) Concerns regarding a higher probability of deep sternal wound infections and its ensuing complications, an increased operation time, and technical challenges including utilizing and teaching the technique, have limited the widespread use...