Internal Mammary Artery Bypass Graft—Long-term Patency Rate and Follow-up

Kay, Earle B.; Naraghipour, H.; Beg, Rais A.; Demaney, Martial; Tambe, A.; Zimmerman, Henry A.

doi:10.1016/s0003-4975(10)64356-1

Cited by 72 publications

(11 citation statements)

References 5 publications

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“…In consistency with our findings, the patency of IMA grafts is reported to be superior to SV graft patency one year after surgery ( 2 , 17). This relationship prevailed throughout the following four years in the present study.…”

Section: Discussionsupporting

confidence: 92%

Angiographic Changes in Internal Mammary Artery and Saphenous Vein Grafts, Two Weeks, One Year and Five Years after Coronary Bypass Surgery

Björk

Ivert

Landou

1981

Scandinavian Journal of Thoracic and Cardiovascular Surgery

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Coronary angiography was performed two weeks after coronary bypass surgery on 112/121 consecutive operative survivors (93%), on 97/119 one-year survivors (82%) and on 79/108 five-year survivors (73%). Occlusions of the grafts were uncommon after the first year. The cumulative five-year patency, calculated with the actuarial method, was 89% for internal mammary artery (IMA) grafts and 77% for aortocoronary saphenous vein (SV) grafts. Almost 70% of the SV grafts exhibited a 15-50% reduced diameter after one year and 10% showed progressive narrowing at five years. Diffuse luminal narrowing did not predict graft failure. The incidence of localized narrowings present at two weeks after surgery was, however, significantly higher among SV grafts, which occluded within one year, than among those patent after five years. In 5% of the IMA grafts the diameter was reduced 15-80% after five years. This was related either to obstruction at the anastomotic site or to low-grade proximal coronary stenosis. No less than 12% of the IMA grafts increased 20-50% in diameter as an adaptation to good distal runoff.

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Section: Discussionsupporting

confidence: 92%

Angiographic Changes in Internal Mammary Artery and Saphenous Vein Grafts, Two Weeks, One Year and Five Years after Coronary Bypass Surgery

Björk

Ivert

Landou

1981

Scandinavian Journal of Thoracic and Cardiovascular Surgery

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“…The exact cause of aneurysmal changes in the bypass graft is unknown. Although dissection has been reported at the site of the graft insertion of either the native coronary artery or the vessel used for the bypass, particularly for internal mammary arteries [15,16], the aneurysm in this case was 3 cm away from the graft insertion. No tied-off branch of the vein was at the aneurysm to create a site of weakness.…”

Section: Discussionmentioning

confidence: 66%

Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries

Bramlet

Behar

Ideker

1982

Cathet. Cardiovasc. Diagn.

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Aneurysm formation in saphenous vein aortocoronary bypass grafts is an extremely rare complication of coronary artery bypass surgery. Aneurysms of native coronary arteries are found in a small percentage of patients at autopsy. Reported is a case with multiple coronary artery aneurysms in which a dissecting aneurysm of the saphenous vein bypass graft also developed following coronary artery bypass surgery. This is the first report of such association.

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“…To avoid the potential risk of spasm of the IMA imme diately after mobilization, topical use of nife dipine has been recommended [16,17], How ever. this is still a matter for discussion since, recently, topical use of sodium nitroprusside to relieve perioperative spasm of the IMA was found to be more effective than nifedipine [ 18]. As mentioned in 'Patients and Methods,' we routinely use papaverine for topical appli cation, and nifedipine, 10 mg, was adminis tered at the time of implantation of the IMA.…”

Section: Discussionmentioning

confidence: 99%

“…In our experience, this has been an acceptable method. Furthermore, it is probably wise to avoid using the very distal part of the IMA since its diameter is usually small and contrac tility in this part is increased [14], The preference for the IMA as bypass con duit lies in its superior flow velocity [18] and its minimal tendency to develop arteriosclero sis [19], Dion et al [3] have reported a 95% patency rate of sequential IMA grafts in 157 patients undergoing recatheterization 6 months postoperatively. This corresponds well with the 12-month clinical follow-up in our series.…”

Section: Discussionmentioning

confidence: 99%

Sequential Internal Mammary Artery Conduits in Coronary Artery Bypass Grafting

Christenson¹,

Bucher²,

Velebit³

et al. 1994

Med Princ Pract

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The results of sequential internal mammary artery (IMA) grafting in myocardial revascularization, with special emphasis on IMA-related morbidity, have been evaluated over a 2-year period. Between June 1,1991 and July 1,1993,638 patients underwent isolated coronary artery bypass grafting (CABG) at our institution, using the IMA as a conduit. In 541 patients, one or both IMAs were used as a single coronary artery bypass conduit (group 1) and, in the remaining 97 patients, sequential IMA grafting was performed (group 2). The mean age was 60.1 ± 9.2 years and 82% of the patients were male. There were 16.6% repeat CABG in group 1 compared to 3.1% in group 2 (p < 0.01). All patients had preoperative angina and 67% were in the Canadian Cardiovascular Society angina class 3 and 4. Other preoperative patient characteristics were similar in both groups. The overall perioperative mortality was 1.9% (12/638). Twelve patients died in group 1. There were no mortalities in group 2. Nonfatal perioperative myocardial infarction occurred in 10 patients in group 1 (1.6%) and in none in group 2. The incidence of re-exploration for bleeding, sternal wound infections, sternal dehiscence or other perioperative complications was low in both groups. Significant IMA spasm or insufficient IMA flow due to small-caliber vessels occurred in only 1.3% (8/638: 6 patients in group 1 and 2 patients in group 2) (n.s.). None of the patients with sequential IMA grafts in group 2 had early graft failure (within 30 days postoperatively). Twelve months postoperatively, 88% (83/94 survivors) of the patients who had received a sequential IMA graft were completely free of angina. Coronary revascularization with sequential IMA graft was found to be safe and effective. Specific IMA problems such as IMA spasm occurred rarely and not more frequently when the IMA was used as sequential graft.

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Internal Mammary Artery Bypass Graft—Long-term Patency Rate and Follow-up

Cited by 72 publications

References 5 publications

Angiographic Changes in Internal Mammary Artery and Saphenous Vein Grafts, Two Weeks, One Year and Five Years after Coronary Bypass Surgery

Angiographic Changes in Internal Mammary Artery and Saphenous Vein Grafts, Two Weeks, One Year and Five Years after Coronary Bypass Surgery

Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries

Sequential Internal Mammary Artery Conduits in Coronary Artery Bypass Grafting

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