Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: a propensity-matched study

Abstract

Background: This study aimed to evaluate the early and mid-term outcomes of a novel strategy of using the in-situ left internal mammary artery (LIMA) with the great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG). Methods: A total of 979 patients took part in this retrospective observational study; 83 patients were propensity-score matched to the LIMA + SVG group and 83 to the LIMA − LAD group. Early mortality, postoperative complications, mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared among the two matched groups after the procedure. Results: No significant differences in early mortality and postoperative complications rates were detected between the two matched groups. For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but there was no significant statistical difference (14.9% vs. 12.8%, hazard ratio =1.20, 95% CI, 0.24 to 7.95; P=0.70) between the matched groups. Computed tomography coronary artery angiography (CTCA) images showed a LIMA + SVG composite graft patency rate of 94% (32/34) 25 months after the procedure. Conclusions: Using the in situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes. These findings may provide an alternative emergency strategy when in situ LIMA cannot bypass LAD. Further study needs to be conducted to test longer-term outcomes.

One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease

“…For the OPCAB group, standard procedures described previously were followed (16). Aspirin was administered 100 mg daily after HCR and OPCAB procedures and then continued for life, while clopidogrel was administered at a dose of 75 mg/day for 12 months.…”

Four case reports of left anterior descending restenosis treated via the internal mammary artery: A literature review

“…The left internal mammary artery (LIMA)–anterior descending coronary artery bypass grafting (CABG) method is the accepted gold standard for managing anterior descending lesions [ 1 ]. The LIMA–left anterior descending artery (LAD) CABG method has a high postoperative long-term patency rate and has gained the unanimous approval of both cardiologists and patients with CHD [ 2 ]. However, with an increasing number of patients undergoing CABG surgery, and in the number of years following CABG, the number of patients with restenosis in the LIMA bridge vessels and the LAD target vessels following CABG is gradually increasing among the coronary patient population.…”

Can the Left Internal Mammary Artery Be Used During Coronary Artery Bypass Graft Surgery in Patients Undergoing Bone Marrow Transplant? A First Case Report

“…The challenging issue is that the best vascular patency, survival, and quality of life are observed in patients whose left internal mammary artery (LIMA) has been used for CABG (4,5).…”

“…Harvesting the LIMA can, on the one hand, increase the risk of infection, malunion, or surgery complications, and on the other hand, if we do not use the LIMA, the lifespan of grants and their patency is usually up to about five years, after this time the patient will need another intervention. However, this time is about ten years or more with the use of the LIMA (4,5).…”