Internal mammary artery graft failure: Clinical features, management, and long-term outcomes

Abstract

ObjectiveData on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization.MethodsA three-hospital retrospective registry, observational and descriptive, with prospective follow-up of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events.ResultsFifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry. Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratioMACE = 1.35; 95% confidence interval (CI): 1.12–3.00, p < 0.01), age of the patient (hazard ratioMACE = 1.85, 95% CI: 1.17–2.11, p < 0.01), presence of diabetes mellitus (hazard ratioMACE = 2.75, 95% CI: 1.13–6.69, p = 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratioMACE = 5.5, 95% CI: 1.40–21.15, p = 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1% and presentation as infarction (hazard ratioDEATH = 1.05, 95% CI: 1.01–2.17, p = 0.01), age (hazard ratioDEATH = 9.08, 95% CI: 2.52–32.69, p < 0.01), and left ventricular ejection fraction (hazard ratioDEATH = 3.68, 95% CI: 1.65–8.18, p < 0.01) were independent predictors of the same.ConclusionsIn this long-term registry, most patients presented with an acute condition (myocardial infarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the management strategy were related with long-term prognosis.

A clinical case of myocardial infarction after coronary artery bypass grafting using the internal mammary artery

“…[6][7][8]11]. Проведение повторной открытой реваскуляризации показано в случае ранней недостаточности шунта (свежий анастомоз, сложная анатомия или извилистый ход шунта, а также выполнение рестернотомии по некоронарным причинам) [12]. При этом острое начало, возраст, наличие сахарного диабета, низкая фракция выброса ЛЖ и развитие инфаркта миокарда являются факторами риска неблагоприятного исхода у данной категории пациентов [13].…”

Dynamic Kinking of Left Internal Mammary Artery Graft

“…Kinking has been reported as a relatively uncommon etiology of LIMA graft failure 1 , 2 . This condition can present with recurrent angina symptoms and may require stent placement to the kinked site.…”