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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 1-12, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
T Ivert, K Huttunen, C Landou and VO Bjork
Of 99 consecutive patients with 101 internal mammary artery grafts, 91 of
97 hospital survivors (94%) underwent angiography 2 weeks after operation,
84 of 96 survivors (88%) after 1 year, 66 of 88 survivors (75%) after 5
years, and 37 of 69 survivors (54%) after 11 years (range 10 to 13 years).
Thirty-five of the 37 patients who consented to a fourth postoperative
angiographic study (95%, confidence limits 86% to 100%) still reported
relieved angina 11 years after the operation, and seven patients (19%,
confidence limits 5% to 33%) were completely free of symptoms. Angiographic
findings in 30 patients with symptoms of angina were progression of the
coronary artery disease in 22, (73%, confidence limits 56% to 91%),
occluded or stenosed grafts in nine (30%, confidence limits 12% to 48%),
and nonbypassed obstructions in six patients (20%, confidence limits 4% to
36%). The cumulative 11-year patency rate was 88%, confidence limits 81% to
95%, for internal mammary artery grafts and 61%, confidence limits 45% to
76% for saphenous vein grafts. Six of 18 saphenous vein grafts (33%,
confidence limits 19% to 58%) occluded in the interval between 5 and 11
years after operation, and gross wall irregularities were observed in six
of the 12 patent saphenous vein grafts. Unligated side branches and
stenosis of the internal mammary artery did not prevent long-term graft
patency. Internal mammary artery graft failures were related to technical
errors during the operation and occurred when the internal mammary artery
was used to bypass a low-grade coronary artery stenosis. In one patient,
regression of a coronary artery stenosis was associated with a marked
decrease in luminal size of the internal mammary artery graft before the
5-year follow-up. This single internal mammary artery graft became occluded
in the interval between 5 and 11 years after the operation. Eleven of 36
internal mammary artery grafts (31%, confidence limits 14% to 47%)
increased 15% to 40% in luminal diameter as a result of increased
myocardial blood demand before the 11-year follow-up.
ARTICLES
Angiographic studies of internal mammary artery grafts 11 years after coronary artery bypass grafting
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
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