HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tsai, T.-P. Search for Related Content PubMed PubMed Citation Articles by Tsai, T.-P. Related Collections Related Articles

Ann Thorac Surg 2000;70:1446
© 2000 The Society of Thoracic Surgeons

---

Correspondence

Using saphenous vein segments to extend internal mammary conduits during MIDCAB when arterial interposition grafts are contraindicated: intermediate term results

^a Chung Shan Medical and Dental College Hospital, No. 110, Taiwan,

e-mail: tsai{at}flower.csh.org.tw

To the Editor

We read with interest the articles by Takahashi and colleagues [1] and Tashiro and associates [2] regarding the extension of internal mammary arteries with interposing radial artery grafts to allow for multiple arterial revascularization. In addition to multiple revascularization, we found that lengthening of the internal mammary graft conduit is also useful in minimally invasive direct coronary artery bypass (MIDCAB). The limited exposure of MIDCAB occasionally impedes adequate harvesting of the internal mammary artery (IMA). To prevent undue tension on the mammary graft, we routinely skeletonize the IMA and add an interposition graft to the distal end of the IMA. Because of a combination of socioeconomic reasons and patients’ aesthetic preference for avoiding upper extremity incisions, we routinely use saphenous veins instead of radial arteries as interposition grafts.

From May 1996 to December 1999 we performed left IMA–left anterior descending artery MIDCAB in 33 patients (30 men, mean age 65.3 years). Ten patients (8 men, mean age 62 years) required lengthening with autologous saphenous vein graft (SVG) segments. The average length of SVG required was 4.6 cm. There was one operative mortality in the MIDCAB without SVG group due to postoperative left ventricular aneurysm rupture. There was no operative mortality in the MIDCAB with SVG group. Patients who received MIDCAB without SVG had uneventful recovery. There were two reported complications in the MIDCAB with SVG group: one subcutaneous emphysema and one transient atrial fibrillation. Follow-up study of both groups of patients revealed no graft failure or IMA malperfusion in either group (mean follow-up, 29 months).

Lengthening of IMA with SVG can be safely performed in MIDCAB when IMA harvesting is limited by exposure and when the use of radial artery interposition grafts is contraindicated. Intermediate-term follow-ups show comparable patency results with conventional MIDCAB.

References

1. Takahashi T., Ohtake S., Ueno T., Koh M., Sawa Y., Matsuda H. Off-pump coronary bypass using interposed radial artery graft. Ann Thorac Surg 1998;66:2096-2098.[Abstract/Free Full Text]
2. Tashiro T., Nakamura K., Iwakuma A., et al. Inverted T graft. Ann Thorac Surg 1999;67:629-631.[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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tsai, T.-P. Search for Related Content PubMed PubMed Citation Articles by Tsai, T.-P. Related Collections Related Articles