Twelve-Year Experience with Bilateral Internal Mammary Artery Grafts

Abstract

A 12 1/2-year experience with 227 patients who underwent coronary revascularization with bilateral internal mammary artery (IMA) and supplemental saphenous vein grafts is presented. There were 725 coronary grafts performed (3.2 per patient). Forty-four IMA grafts were sequential. In 42 patients, the right IMA was placed through the transverse sinus to revascularize the circumflex artery. Operative mortality was 4% (9 of 227 patients). Postoperative complications included sternal infection (4 patients), reexploration for bleeding (5), and diaphragmatic dysfunction (10). Postoperative arteriography in 30 patients (mean interval, 4 1/4 years) revealed that 92% (34/37) of the left IMA and 87% (26/30) of the right IMA grafts were patent. Late follow-up was complete in 207 surviving patients. Eighteen late deaths (9 cardiac and 9 noncardiac) occurred. Actuarial survival was 83% at 10 years after operation. Of 68 patients followed from 8 to 12 1/2 years (mean interval, 10 1/2 years), 69% were asymptomatic, and 28% were in New York Heart Association Functional Class II. We conclude that bilateral IMA grafting can be accomplished with low operative risk and provides excellent long-term results.

Graft flow assessment with transthoracic Doppler after coronary arterial bypass grafting with bilateral internal thoracic arteries using Y-graft technique

“…The left internal thoracic artery (LITA) has proved to be an excellent conduit as a bypass graft because it has had a better long-term patency rate than other grafts (saphenous vein, radial artery) [1,2]. Angiography is considered the gold standard for graft assessment, however besides being an invasive and costly test, LITA angiography can be painful for the patient, adds to the risk contrast induced nephropathy.…”

Enxertos arteriais na cirurgia de revascularização do miocárdio: papel da artéria radial

“…Todavia, sua baixa patência a médio e longo prazo compromete o resultado cirúrgico final (2)(3)(4) levando os cirurgiões a pensarem alternativas para solução deste problema. A utilização de enxertos arteriais na CRM iniciou há 30 anos com a artéria torácica interna esquerda, usualmente chamada de artéria torácica interna esquerda (ATIE) (5) que atingiu ótimos resultados a longo prazo (3,(6)(7)(8) e atualmente é considerada padrão ouro neste procedimento (9)(10)(11)(12)(13) . A partir dos benefícios demonstrados com a ATIE, outros enxertos arteriais foram testados com resultados animadores.…”

Optimização da perviabilidade do enxerto venoso na revascularização miocárdica: compreensão da fisiopatologia, novas drogas e avanços técnicos

“…Desde 1977, quando FAVALORO et al (1) empregaram, pela primeira vez, a veia safena autológa como um conduto arterial na revascularizado coronária, este enxerto venoso tem se consagrado como o mais largamento empregado não obstante a sua perviabilidade a longo prazo tenha sido apontada como um fator critico, principalmente quando se compara com a longevidade dos enxertos arteriais (2) .…”