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OBJECTIVE:
Saphenous vein graft (SVG) is useful to extend the arterial graft by end-to-end anastomosis to the arterial graft. Lengthening of internal mammary artery (IMA) conduit can be performed in minimally invasive coronary artery bypassing (MIDCAB) when harvesting is limited by exposure, not adequate the mammary artery blood flow and when the use of radial artery interposition graft is contraindicated. Will their long-term results be acceptable or not need to be defined.
METHODS:
We retrospectively studied 33 MIDCAB patients who had LIMA grafting to LAD during May 1996 to December 1999 (30 men, mean age 65.3 years). Ten patients (8 men, mean 62) required lengthening with autologus SVG segments. The average length of SVG required was 4.6 cm. We use noninvasive Doppler ultrasound velocimetry study and multi-detector computed tomographic (MDCT) coronary angiography to evaluate the graft patency and flow characteristics for follow up.
RESULTS:
There was no operative mortality in the MIDCAB with SVG group. One operative mortality in the MIDCAB without SVG group due to postoperative left ventricular aneurysm rupture. There were two reported complications in the MIDCAB with SVG group; one subcutaneous emphysema and one with transient atrial fibrillation. Follow-up study revealed no graft failure or IMA malperfusion in either IMA or IMA with SVG group. (mean follow-up 10 year and 2.9 months)
CONCLUSIONS:
Lengthening of IMA with SVG can be safely performed in MIDCAB surgery when IMA harvesting is limited by exposure, not adequate the mammary artery blood flow and when the use of radial artery interposition grafts is contraindicated. Long-term follow-up show comparable patency results in SVG group with conventional MIDCAB without SVG group (with IMA graft only).