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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 668-675, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
HB Barner, JW Standeven and J Reese
From Feb. 1, 1972, to Jan. 30, 1984, 1,000 patients had isolated coronary
bypass with at least one internal mammary artery, and 103 of them had
bilateral internal mammary artery grafts. There were 1,395 associated vein
grafts and 1,158 internal mammary artery anastomoses, for a total of 2,556
grafts (2.5 per patient). Patients were followed up for 1 to 12 years (mean
6.3 years) and 77 patients were lost to follow-up at a mean of 4.0 years.
Operative mortality was 1.4%, with 11 of 14 deaths in the first 240
patients (4.6%) and eight of 14 in the 103 patients with bilateral internal
mammary artery grafts. There were 93 late deaths, with an actuarial
survival rate of 93% at 5 years and 84% at 10 years. Angina occurred at a
mean rate of 6.2% +/- 1.2% per year. Perioperative infarction was detected
in 37 patients (3.7%). Late infarction occurred in 75 patients, for a mean
rate of 1.5% +/- 0.3% per year. Reoperation (or percutaneous transluminal
coronary angioplasty) was necessary in 35 patients, for a mean rate of
0.85% +/- 0.28% per year. Graft patency was assessed by 1,029 follow-up
catheterizations in 519 patients. The patency rate of the left internal
mammary artery was 96.4% at 1 year, 88.1% at 5 years, and 88.1% at 10
years. That of the right internal mammary artery was 92.8% (p = NS) at 1
year, 84.6% (p = NS) at 5 years, and at 10 years the numbers were too small
to be meaningful. Comparison of patency rates for all internal mammary
artery grafts with vein grafts gave 1 year graft patency rates of 95.7%
versus 93.4% (p less than 0.025), 5 year rates of 87.9% versus 74.0% (p
less than 0.001), and 10 year rates of 83.0% versus 41.0% (p less than
0.001). Included in these patency data are 20 free internal mammary artery
grafts; 16 were studied (mean 2.3 years) and 12 of these 16 (75%) were
patent. Of the 58 sequential internal mammary artery grafts, 18 were
studied by catheterization (mean interval 2.0 years); 35 of 36 anastomoses
were patent and one end-to-side anastomosis was closed. Morbidity and
mortality for patients having internal mammary artery grafting are
comparable to those of patients having saphenous vein bypass only. The
demonstrated superior patency for internal mammary artery grafts supports
the routine use of bilateral internal mammary artery grafting.
ARTICLES
Twelve-year experience with internal mammary artery for coronary artery bypass
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