(Circulation. 1999;100:2353.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Frequency of Early Occlusion and Stenosis in a Left Internal Mammary Artery to Left Anterior Descending Artery Bypass Graft After Surgery Through a Median Sternotomy on Conventional Bypass
Benchmark for Minimally Invasive Direct Coronary Artery Bypass
From the Division of Cardiovascular Diseases and the Section of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn (P.B.B., H.V.F.); Division of Cardiology, Stanford University, Stanford, Calif (E.L.A.); and Bayer Corporation, West Haven, Conn (A.N.).
Correspondence to Peter B. Berger, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail berger.peter{at}mayo.edu
Background—Uncertainty exists regarding the frequency of early occlusion when the left internal mammary artery (LIMA) is anastomosed to the left anterior descending artery (LAD) through a sternotomy with conventional coronary artery bypass grafting (CABG). The issue has gained importance for comparison with less invasive surgical approaches in which operative exposure may be limited and graft anastomosis more difficult.
Methods and Results—Data were analyzed from the
International Multicenter Aprotinin Graft Patency Experience (IMAGE)
trial in which 617 patients underwent conventional CABG of the LAD with
a LIMA between April 1993 and May 1995. Coronary angiography
was performed a mean of 10.8 days postoperatively. Patients were
randomized to receive intraoperative aprotinin, an
inhibitor of several serine proteinases, or placebo.
Because no differences existed in patency rates of LIMA grafts between
patients who received aprotinin and placebo, both groups were
analyzed collectively. On coronary angiography, the
LIMA was widely patent (<50% stenosis) in 561 patients
(91%), had 
50% and <99% stenosis in 48 patients (7.8%),
and was occluded in 8 patients (1.3%). Therefore, the LIMA was patent
in 609 patients (98.7%).
Conclusions—In the IMAGE trial, the largest and most contemporary early angiographic analysis of CABG available, early patency of the LIMA was >98% when anastomosed to the LAD. These data provide an important benchmark for less invasive surgical approaches in which the LIMA is anastomosed to the LAD.
Key Words: cardiopulmonary bypass • angiography • trials • coronary disease • revascularization
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