Coronary artery bypass grafting with left internal mammary artery and right gastroepiploic artery, with and without bypass

We examined the hypothesis that the short term clinical and angiographic outcome of skeletonized Left Internal Mammary Artery (LIMA) is better than that of pedicled LIMA used for revascularization of left anterior descending artery at CABG surgery at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute from May 2011 to April 2012. Accordingly we studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery (LAD). In 30 consecutive LIMAs were harvested as a pedicle (Control Group) and another 30 consecutive LIMAs were harvested as skeletonized graft (Experimental Group). Three diameters of the LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis. Our study shows that, complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001). Although there was similar incidence of superûcial wound complications between the groups, the post CABG pain (PCP) was significantly higher in pedicled group at the 6 month follow-up. Check coronary angiography showed the LIMA grafts to the LAD were all patent. There was increased diameter achievement in skeletonized group at the anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). We conclude that skeletonized LIMA showed a better functional behavior, giving longer conduit length and superior postoperative clinical and angiographic profile.University Heart Journal Vol. 12, No. 2, July 2016; 82-87

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Multiple Left Internal Mammary Artery-to-Pulmonary Artery Fistulae 15 Years after Coronary Artery Bypass Grafting

Texas Heart Institute Journal ◽

10.14503/thij-12-3132 ◽

2014 ◽

Vol 41 (1) ◽

pp. 94-96 ◽

Cited By ~ 4

Author(s):

Tushar C. Barot ◽

Angelo LaPietra ◽

Orlando Santana ◽

Nirat Beohar ◽

Joseph Lamelas

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Pulmonary Artery ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary

Left internal mammary artery (LIMA)-to-pulmonary artery fistulae rarely develop after coronary artery bypass grafting. Fewer than 30 cases of these fistulae have been reported since 1947. Nevertheless, this entity should be considered as a cause of recurrent angina after bypass surgery, in the absence of other causes. We present the case of a 67-year-old man with cardiac symptoms in whom multiple LIMA-to-pulmonary artery fistulae were found, 15 years after he had undergone coronary artery bypass grafting. The diagnosis was confirmed by means of coronary angiography with selective catheterization of the LIMA and by computed tomographic angiography of the heart. The patient underwent reoperative 2-vessel coronary artery bypass grafting and ligation of multiple fistulae; 16 months postoperatively, he was asymptomatic and doing well. In addition to reporting this case, we discuss relevant diagnostic and treatment considerations.

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Left Internal Mammary Artery in Coronary Artery Bypass Grafting And Justification for Non-Use

International Journal of Surgery ◽

10.1016/j.ijsu.2010.07.079 ◽

2010 ◽

Vol 8 (7) ◽

pp. 531

Author(s):

N.A. Hirst ◽

R.W. White

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary

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Successful percutaneous treatment of a catastrophic left internal mammary artery graft avulsion occurring 4 weeks post-coronary artery bypass grafting surgery: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa524 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

Shana Tehrani ◽

Sudhir Rathore

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary ◽

Life Threatening

Abstract Background Avulsion of the left internal mammary artery (LIMA) graft near the anastomosis to the left anterior descending artery (LAD) artery post-coronary artery bypass grafting (CABG) is a rare but potentially catastrophic complication which can result in sudden ischaemia, haemodynamic compromise and life-threatening bleeding into the pericardium. Case summary We report a case of a spontaneous LIMA graft avulsion at the site of the anastomosis to the LAD artery, which occurred 4 weeks post-conventional CABG surgery and resulted in anterior myocardial infarction (MI), cardiac tamponade and cardiogenic shock. This life-threatening event was treated by deploying a covered stent in the LAD artery and by coiling the dehisced LIMA graft. Discussion To our knowledge, this is the first report of late LIMA graft avulsion that has been uniquely and successfully treated by percutaneous coronary intervention.

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Left or bilateral internal mammary artery employment in coronary artery bypass grafting: midterm results

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321990764 ◽

2021 ◽

pp. 021849232199076

Author(s):

Mikhail Sergeevich Fomenko ◽

Yuri Alexandrovich Schneider ◽

Victor Gennadievich Tsoi ◽

Alexander Anatolyevich Pavlov ◽

Pavel Alexandrovich Shilenko

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Mammary Arteries ◽

Internal Mammary

Background The gold standard for coronary artery bypass grafting to the left anterior descending artery is use of the left internal mammary artery. Better long-term survival has been reported using bilateral internal mammary arteries compared to left internal mammary artery only, but many surgeons are reluctant to employ bilateral internal mammary arteries in coronary artery bypass grafting. This study aimed to evaluate the effectiveness and safety of bilateral internal mammary artery use. Methods From 2014 to 2017, 1703 patients underwent coronary artery bypass grafting in our institute. Of these, 772 met the inclusion criteria and were randomly assigned to receive bilateral ( n = 387) or left ( n = 385) internal mammary artery grafts. The mean age was 67.1 ± 6.0 years (range 48–85 years) and 474 (61.4%) were male. The mean number of diseased vessels was 3.1 ± 0.9, and mean EuroSCORE II was 3.4% ± 1.1%. Results Hospital mortality was 1.2% in the left internal mammary artery group vs. 1.8% in the bilateral internal mammary artery group ( p = 0.55). There was no difference in procedure-related complications between groups. Mean follow-up was 65.9 months. Survival in the bilateral internal mammary artery group at 1, 3, and 5 years was 98.7%, 98.7%, and 94.8% vs. 98.1%, 98.1%, and 90.9%, respectively, in the left internal mammary artery group ( p = 0.63). Conclusion Application of bilateral internal mammary arteries in coronary artery bypass grafting is safe and effective, with comparable midterm results to those with the left internal mammary artery only.

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