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The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 414-431, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AS Geha, RJ Krone, JR McCormick and AE Baue
Results of direct coronary revascularization with 511 grafts in 213
patients from 1971 to 1974 are reviewed. To improve an early saphenous vein
graft (SVG) patency of 84 per cent in the first 85 patients, we have used
internal mammary artery grafts (IMAG), when possible, since January, 1973.
In 1973 to 1974, 15 patients had SVG's only (36 grafts) and 113 received
one or two IMAG's with or without additional SVG's (total 282 grafts); in
26 we used a crossed double IMAG. Forty-seven of 48 patients with unstable
angina survived and did well. Flows in SVG's and IMAG's were comparable.
Flows in right IMAG's to diagonal or marginal vessels were higher than in
right IMAG's to right or left anterior descending (LAD) vessels. In 12
patients with both SVG and IMAG, there was no difference in flow response
of either graft to vasoactive drugs. Survival, functional, and patency
results with IMAG's were as good as or better than results with SVG's. We
conclude that IMAG's yield higher patency and comparable flow rates to
SVG's and should be used when the IMA approximates the recipient artery in
size and when a high pulsatile free flow is measured from the end of the
graft. IMAG's are also safe and feasible for unstable angina.
ARTICLES
Selection of coronary bypass. Anatomic, physiological, and angiographic considerations of vein and mammary artery grafts
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