Angiographic studies of internal mammary artery grafts 11 years after coronary artery bypass grafting

Ivert, Torbjörn; Huttunen, K; Landou, Christian; Björk, Viking Olov

doi:10.1016/s0022-5223(19)35290-0

Cited by 129 publications

(30 citation statements)

References 39 publications

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“…Barner reported LIMA graft dysfunction due to low‐grade narrowing of the LAD, resulting in high competitive flow. The authors called this phenomenon “disused atrophy.” Ivert et al postulated that the main causes of LIMA graft failure are low‐grade stenosis of bypassed coronary artery and technical problems with the anastomosis. Shimizu et al reported that LIMA grafts showed diffuse narrowing of the lumen on angiography (“string sign”) in all their patients with coronary stenosis of 40% to 59%.…”

Section: Discussionmentioning

confidence: 99%

Results of Coronary Artery Bypass Grafting in Myocardial Bridging of Left Anterior Descending Artery

et al. 2013

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Background: We aimed to evaluate the graft patency rate following coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD) with proximal myocardial bridging (MB). While MB is generally a benign coronary abnormality, ischemia, stunning, and sudden death have been reported. In symptomatic patients with proximal LAD systolic compression of >50%, positive for ischemic noninvasive testing and noneffective optimal medical therapy, coronary intervention could be indicated. Few studies of CABG in myocardial bridging have been reported. The influence of high flow in coronaries with MB on graft patency is cause for concern. Methods: We retrospectively studied 39 patients operated on for isolated MB of proximal LAD with >50% systolic compression. All patients were severely symptomatic despite optimal medical therapy and positive noninvasive tests for myocardial ischemia. CABG was performed through the midsternotomy with cardiopulmonary bypass and cardioplegia. Patients were divided into two groups: in 20 patients, LAD was bypassed with left internal mammary artery (LIMA) (Group 1) and in 19 patients with saphenous vein graft (SVG) (Group 2). All patients underwent follow-up coronary angiography. Results: Demographics and degree of systolic compression of the LAD were similar in both groups. There was no mortality or major morbidity. Freedom from angina was 68% in Group 1 and 94% in Group 2 at 18 months postoperatively (p = 0.58). Twelve LIMA grafts and three SVGs were found occluded (p = 0.002). Conclusions: LIMA patency in myocardial bridging of the LAD can be low. SVGs should be considered in cases of CABG for myocardial bridging.

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Section: Discussionmentioning

confidence: 99%

Results of Coronary Artery Bypass Grafting in Myocardial Bridging of Left Anterior Descending Artery

et al. 2013

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“…Many LIMA patients have patent side branches without complaints. For example, Ivert et al [2] followed 36 patients for 11 years after CABG and found that in 6 patients with significant IMA side branches, none had anginal symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The internal mammary artery (IMA) is the conduit of choice in coronary artery surgical revascularization because of favorable long‐term patency rates and prognosis compared to saphenous vein grafts [1, 2]. Rarely, angina after coronary artery bypass grafting (CABG) is thought to occur as a result of coronary steal when large side‐branch thoracic arteries originate from the internal thoracic artery.…”

Section: Introductionmentioning

confidence: 99%

Fallacy of thoracic side‐branch steal from the internal mammary artery: Analysis of left internal mammary artery coronary flow during thoracic side‐branch occlusion with pharmacologic and exercise‐induced hyperemia

Guzon

Klatte

Moyer

et al. 2003

Cathet Cardio Intervent

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In some patients, myocardial ischemia after coronary artery bypass graft surgery has been attributed to a coronary steal phenomenon through a thoracic side branch originating from the left internal mammary artery (LIMA), even in the absence of subclavian or LIMA stenosis. To demonstrate that coronary flow through the LIMA is unchanged by occlusion of a LIMA side branch, we examined LIMA coronary flow velocity measurements (0.014" Doppler flow wire) in three patients at rest, during adenosine hyperemia, and again during hyperemia induced by left arm exercise before and again after the balloon occlusion of the thoracic side branch. For the three patients, no significant changes in resting or hyperemic flow were noted due to side-branch occlusion. Before side-branch occlusion, pharmacologic intra-arterial (adenosine) coronary flow reserve (hyperemic-to-basal flow velocity ratio) was 2.6, 1.5, and 3.2 and exercise flow reserve was 2.1, 1.3, and 1.2, respectively. After side-branch occlusion, pharmacologic coronary flow reserve was 2.5, 1.8, and 2.7 with exercise flow reserve of 1.8, 1.1, and 1.3, respectively. Under most ordinary circumstances, thoracic side-branch steal does not exist and that side-branch occlusion does not alter LIMA flow at rest or during pharmacologic or exercise-induced hyperemia. These data further suggest that a demonstration of the physiologic value of side-branch occlusion should precede surgical or percutaneous interruption of the thoracic artery in such patients.

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“…In more than 30 years of experience in CABG, many studies demonstrated the superiority of the internal thoracic artery (ITA) graft in terms of long patency rate to the saphenous vein (SV); therefore, ITA is routinely used by many surgeons to obtain a safe and durable myocardial revascularization, what reduced the reoperation rate and increased the long-term survival. [1][2][3][4] In the last 20 years, due to described higher patency rates of ITA than SV, there has been a change in the choice of the conduits and CABG with double ITAs was well-accepted because of its satisfactory outcome. [5][6][7][8] The results with the use of double ITAs became rapidly satisfactory, so that this practice was extended also to those patients with left main stem disease.…”

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confidence: 99%

Right Gastroepiploic Artery Graft: Long-Term Clinical Follow-Up in 271 Patients?Experience of a Single Center

et al. 2006

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Angiographic studies of internal mammary artery grafts 11 years after coronary artery bypass grafting

Cited by 129 publications

References 39 publications

Results of Coronary Artery Bypass Grafting in Myocardial Bridging of Left Anterior Descending Artery

Results of Coronary Artery Bypass Grafting in Myocardial Bridging of Left Anterior Descending Artery

Fallacy of thoracic side‐branch steal from the internal mammary artery: Analysis of left internal mammary artery coronary flow during thoracic side‐branch occlusion with pharmacologic and exercise‐induced hyperemia

Right Gastroepiploic Artery Graft: Long-Term Clinical Follow-Up in 271 Patients?Experience of a Single Center

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