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The Annals of Thoracic Surgery, Vol 42, 449-465, Copyright © 1986 by The Society of Thoracic Surgeons
LR Sauvage, HD Wu, TE Kowalsky, CC Davis, JC Smith, EA Rittenhouse, DG Hall, PB Mansfield, SR Mathisen and Y Usui
Long-term follow-up data from several leading centers concerning patients
undergoing coronary artery bypass clearly demonstrate the superiority of
the internal mammary artery (IMA) with patency rates of 83 to 94% at 7 to
12 years compared with the saphenous vein and its patency rates of 41 to
53%. Our experimental studies provide a biological basis for understanding
this difference. Thin-walled arterial autografts undergo no histological
change after being implanted in the arterial system, while venous
autografts undergo major changes with an initial scattered loss of
endothelium and marked thickening due to a proliferative reaction. The
challenge to the cardiac surgeon is to revascularize the entire left
ventricle with the IMAs. We have found this possible in most patients with
advanced three- vessel disease by using both IMAs either as in situ grafts
or free grafts with as many sequential anastomoses as necessary to achieve
full revascularization. Our use of the term in situ refers to the graft's
origin from the subclavian artery as opposed to a free IMA graft arising
from another site.
ARTICLES
Healing basis and surgical techniques for complete revascularization of the left ventricle using only the internal mammary arteries
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