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Ann Thorac Surg 2000;69:1649-1650
© 2000 The Society of Thoracic Surgeons

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Correspondence

Left internal mammary artery branches after minimally invasive harvesting

^a Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, Sydney NSW 2050 Australia,

e-mail: paulp{at}cts.rpa.cs.nsw.gov.au

To the Editor

Calafiore and colleagues have elegantly examined the anatomy and size of persistent left internal mammary artery (LIMA) branches after use of the vessel as a coronary artery graft after harvesting both in an open fashion (sternotomy) and a minimally invasive fashion (left anterior small thoracotomy) [1]. Part of their conclusion, however, that the number and nature of these persistent (or perhaps newly developing) branches is independent of the harvesting technique, appears to be at variance with the data presented.

Considering only those patients in whom a persistent lateral costal branch, persistent first intercostal branch, or any other branch greater than 1 mm diameter was seen (and disregarding those branches of less than 1 mm in diameter), in the minimally invasive group, these numbered 54 of 150, and in the open group, these numbered 21 of 150, a 2.5 times increased incidence in the minimally invasive group and a statistically significant difference by ² test with p less than 0.0001, relative risk 1.69 (95% confidence interval [CI] 1.37 to 2.06) and an odds ratio of 3.45 (95% CI 1.95 to 6.10).

Whether these large persistent branches represent a clinically important entity is not addressed by this investigation and remains unclear. There are conflicting clinical and physiologic reports describing the possible relationship between such branches and residual or recurrent angina [2, 3]. However, on the basis of these data, it is possible to say that LIMA harvesting by left anterior small thoracotomy is a risk factor for the presence of persistent large LIMA branches as described.

References

1. Calafiore A.M., Contini M., Iaco A.L., et al. Angiographic anatomy of the grafted left internal mammary artery. Ann Thorac Surg 1999;68:1636-1639.[Abstract/Free Full Text]
2. Gaudino M., Serricchio M., Glieca F., et al. Steal phenomenon from mammary side branches. Ann Thorac Surg 1998;66:2056-2062.[Abstract/Free Full Text]
3. Hartz R.S., Heuser R.R. Embolization of IMA side branch for post-CABG ischemia. Ann Thorac Surg 1997;63:1765-1766.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul Peters Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Peters, P. Search for Related Content PubMed Articles by Peters, P. Related Collections Related Article