Routine use of the left internal mammary artery graft in the elderly

Gardner, Timothy J.; Greene, Peter S.; Rykiel, Mary F.; Baumgartner, William A.; Cameron, Duke E.; Casale, Alfred S.; Gott, Vincent L.; Watkins, Levi; Reitz, Bruce A.

doi:10.1016/0003-4975(90)90137-u

Cited by 89 publications

(39 citation statements)

References 10 publications

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“…We and many others have reported better survival and less reintervention for recurrent ischemia in patients undergoing bilateral versus single ITA grafting. 1,2,[19][20][21][22][23][24] However, a few studies have reported similar outcomes for both strategies. 25,26 A possible explanation for these different observations is that all bilateral ITA revascularization strategies are not equally effective.…”

Section: Discussion Backgroundmentioning

confidence: 99%

Does Location of the Second Internal Thoracic Artery Graft Influence Outcome of Coronary Artery Bypass Grafting?

et al. 2008

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Background-We sought to determine whether location of the second internal thoracic artery (ITA) graft used for bilateral ITA grafting affects mortality and morbidity of patients with 3-system coronary artery disease and to identify factors associated with second ITA location. Methods and Results-From January 1972 to June 2006, 3611 patients with 3-system coronary artery disease underwent bilateral ITA grafting with one graft anastomosed to the left anterior descending system and the second to either the circumflex (nϭ2926) or right coronary artery (nϭ685) system. Follow-up was 9.2Ϯ7.2 years. Propensity score methodology was used to obtain risk-adjusted outcome comparisons between patients with the second ITA to circumflex versus right coronary artery. Hospital mortality (0.34% versus 0.58%; Pϭ0.4), stroke (0.96% versus 0.88%; Pϭ0.8), myocardial infarction (1.3% versus 0.73%; Pϭ0.2), renal failure (0.44% versus 0.29%; Pϭ0.6), respiratory insufficiency (3.5% versus 3.8%; Pϭ0.7), and reoperation for bleeding (3.4% versus 3.2%; Pϭ0.8) were similar in patients who received the second ITA to circumflex or right coronary artery and remained similar after propensity score adjustment. Late survival (86% versus 87% at 10 years) was also similar. Despite this, there was a gradual decline in ITA to right coronary artery grafting. Conclusions-Contrary to prevailing wisdom that the second ITA graft should be anastomosed to the next most important left-sided coronary artery in 3-system coronary artery disease, it may be placed to either the circumflex or right coronary artery system with similar early and late outcomes.

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Section: Discussion Backgroundmentioning

confidence: 99%

Does Location of the Second Internal Thoracic Artery Graft Influence Outcome of Coronary Artery Bypass Grafting?

et al. 2008

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“…It has had an important impact on practice patterns. 7 Although surgeons have been using the LIMA more frequently in difficult clinical situations, including elderly patients, 8 this report will encourage an even wider use of the best conduit available to cardiovascular surgeons for the performance of a coronary bypass. In fact, the trend toward total arterial revascularization, especially in the younger patient, has grown based on the excellent data with first one IMA and then two IMAs.…”

Section: See P 507mentioning

confidence: 90%

Use of the Internal Mammary Artery Graft and In-Hospital Mortality and Other Adverse Outcomes Associated With Coronary Artery Bypass Surgery

Cohn

2001

Circulation

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he use of the left internal mammary artery (LIMA) to bypass the left anterior descending artery (LAD) is the "gold standard" of coronary artery revascularization, recognized by interventionalists and surgeons alike. The better size match with the coronary artery, the single anastomosis, and the biochemical and physical qualities of this conduit for the most important coronary artery in the human circulation, the LAD, are clear advantages over the saphenous vein graft. 1 The seminal paper by Loop et al 2 showed the important influence of this operation on the longevity of patients who are operated on for coronary artery disease, and their data have been substantiated by others. 3,4 See p 507Nevertheless, the IMA has not been generally used by surgeons in the variety of clinical coronary artery syndromes requiring coronary artery bypass grafting (CABG) because of some relative contraindications. These have included left ventricular hypertrophy, severe left ventricular dysfunction, emergency operations, chronic obstructive pulmonary disease with enlarged lungs, advanced age, and an obstructed left subclavian artery. 4 Theoretically, increased conduit blood flow is considered necessary in these situations, and this was thought best provided by a saphenous vein graft to the LAD rather than a LIMA. Thus, the LIMA was not recommended for emergent/urgent situations or in patients with the above complications. Also, the longer harvest time of the IMA and the increased bleeding tendency of the emergent patient, especially those undergoing interventional procedures in the cardiac catheterization laboratory who may be on some form of anticoagulation and in the fragile elderly, were also considered contraindications to the use of the LIMA. Therefore, in the comprised patient with any of the above stipulations, even the young, the LIMA has not been generally used.This prospective study by Leavitt and colleagues 5 of Ͼ21 000 patients undergoing CABG for the first time who had their surgery performed in the "modern" era (between 1992 to 1999) has refuted many of these long-held beliefs. In every clinical situation, including the aforementioned ones heretofore thought relative contraindications, the use of this conduit for LAD coronary bypass was positively correlated with improved survival when compared with the use of a venous conduit to the LAD. Although this study would seem to be counterintuitive for the reasons cited above, it is an important study when one looks at the current trends in coronary bypass surgery and the pathophysiology of failed grafts.At present, CABG is performed extremely well and significantly better than in the 1970s and 1980s, when the relative contraindications were suggested. Even in the emergent situation, most experienced surgical units can harvest the LIMA in a relatively short time, with little or no blood loss despite the use of intravenous antiplatelet agents from the catheterization laboratory. The suture techniques, the familiarity with physiology, and the use of intraoperative and postoper...

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“…Esta última contraindicación es prácticamente definitiva para el uso de doble mamaria (10). La edad no es una contraindicación, nosotros utilizamos la AMi en pacientes de más de 70 años sin complicaciones y esta decisión está avalada por estudios recientes que demuestran mayor sobrevida a 4 años en pacientes que reciben AMi en comparación a sujetos que únicamente tuvieron puentes de vena safena; esta diferencia tiene valor estadístico significativo (11). Como lo demuestra el cuadro N°2, la AMi es la que hemos usado con mayor frecuencia (más de 90% de casos) anastomosada a la DA.…”

Section: Discussionunclassified

La mamaria interna en la revascularización miocárdica. A propósito de 486 casos. Técnica quirúrgica y resultados.

Bracamonte¹,

Alcantara²,

Aste³

et al. 2013

Rev Med Hered

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La mamaria interna en la revascularización miocárdica. A propósito de 486 casos. Técnica quirúrgica y resultados. SUMMARYInternal mamary artery has shown to be ideal conduit because of greater early and late patency when compared to saphenous vein graft. This paper summarizes our experience with this artery as a contribution to the development of this technique in our media. Since 1986 we have operated 486 patients who have received at least one mammary artery. 386 were operated in France (group I), and 100 in Perú (group II). 95% of patients received the left mammary artery to the left anterior descedent artery in, 4 patients the right internal mammary artery as a free graft and in 12 cases associated to the left internal mammary artery. Overall early mortality was 3.5% with few post-operative complications. The follow up of patients in group II, showed actuarial survival rate of 94% at 7 years, free of cardiac illness, and very few late cardiac complications, when compared with international publications. Appropiate indications and a good technique in the use of the internal mamary arteries does nor increase early morbimortality and has good long term results, as has been showed in the follow up of the group II patients operated in Lima. (Rev Med Hered 1993; 4(2): 75-80)

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Routine use of the left internal mammary artery graft in the elderly

Cited by 89 publications

References 10 publications

Does Location of the Second Internal Thoracic Artery Graft Influence Outcome of Coronary Artery Bypass Grafting?

Does Location of the Second Internal Thoracic Artery Graft Influence Outcome of Coronary Artery Bypass Grafting?

Use of the Internal Mammary Artery Graft and In-Hospital Mortality and Other Adverse Outcomes Associated With Coronary Artery Bypass Surgery

La mamaria interna en la revascularización miocárdica. A propósito de 486 casos. Técnica quirúrgica y resultados.

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