J Thorac Cardiovasc Surg 1998;116:667-668
© 1998 Mosby, Inc.
The addition of saphenous vein graft to the left anterior descending artery in left internal thoracic artery hypoperfusion syndrome
Joseph Galea, MD, FRCS,
Walter Busuttil, MD, FRCS,
Alexander Manché, MPhil, FRCS(CT)
G'Mangia, Malta
Department of Cardiothoracic Surgery, St. Luke's Hospital, G'Mangia, Malta
To the Editor:
We read with interest the article on the surgical management of the left internal thoracic artery (LITA) hypoperfusion syndrome by Zünd and colleagues, published in the September 1997 issue of The Journal of Thoracic Cardiovascular Surgery.
1 We agree that the addition of a saphenous vein graft (SVG) to the hypoperfused left anterior descending (LAD) artery territory despite LITA graft implantation is beneficial to the patient, especially in the acute phase. Although there was no mortality from the ITA hypoperfusion syndrome in this series, it is a serious condition that is potentially lethal, 2,3 and reoperation is associated with increased morbidity. 4 In our practice, the addition of an SVG to a hypoperfused LAD is performed during the original period of cardioplegic arrest (along with the other elective grafts) and before clinical signs of ITA hypoperfusion syndrome occur. We implant an additional SVG to the LAD when the LITA is small and the flow is adequate but suboptimal. We are very pleased to note that the long-term flow rate of the LITA and SVG are satisfactory and there are no negative effects of one graft on the other, because we have not been able to carry out these measurements in our unit. The distance between the ITA graft and the suppplemental SVG was not discussed in this article, but recently it was shown that an increase in this distance improves the LITA graft survival. 5 We believe that our approach of prophylactically adding an SVG to a potentially hypoperfused LAD territory is less traumatic to the patient and to the surgical team.
References
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Zünd G, Hauser M, Vogt P, Davis CP, Lachat M, Künzli A, et al. New approach to patency and flow assessment after left internal thoracic artery hypoperfusion syndrome with additional saphenous vein graft to the left anterior descending artery with phase-contrast magnetic resonance angiography. J Thorac Cardiovasc Surg 1997;114:428-33. [Abstract/Free Full Text]
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Pagni S, Salloum E, Storey J, Montgomery W, Cerrito P, Van Himbergen D, et al. Double grafting of the left anterior descending artery: Is the distance between the internal mammary artery and supplemental vein graft anastomoses relevant in graft survival? Eur J Cardiothorac Surg 1998;13:36-41. [Abstract/Free Full Text]
