Abstract
Background
Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. An angiographically normal lumen in a patent graft, in the late period, would predict ongoing patency thereafter; whereas an irregular lumen would predict progression of conduit atheroma and possible failure in the long term.
Objectives
The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma.
Methods
Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. Generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity.
Results
50 patients underwent coronary angiography at overall duration postoperative 13.1±2.9, and age 74.3±7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P=0.265; and both were significantly better than SVG 17.5%, P<0.001. Patency RA 93.5% was also not different to IMA 96.8%, P=0.146, and both arterial conduits were significantly higher than SVG 82.5%, P=0.029. Grafting according to coronary territory was not significant for perfect patency, P=0.961 and patency 0.201. Coronary stenosis predicted perfect patency for RA only, P=0.030 and for patency, RA, P=0.007, and SVG, P=0.032.
When both arterial conduits were combined, perfect patency, P<0.001, and patency, P=0.017, were superior to SVG.
Conclusions
All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.
Reconstruction of long left anterior descending coronary artery successive lesions with left internal mammary artery and saphenous vein graft angioplasty: Early encouraging results
