PURPOSE: Saphenous vein graft (SVG) segment 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 MIDCAB when harvesting is limited by exposure, inadequate blood blow and when the use of artery interposition grafts is contraindicated. Will their long-term results be acceptable or not needs to be defined.
METHODS: We retrospectively studied 33 MIDCAB patients (pts) (who had LIMA grafting to LAD) during the period between May 1996 to Dec 1999 (30 men, mean age 65.3 years). Ten pts (8 men, mean 62) required lengthening with autologous SVG segments. The average length of SVG required was 4.6 cm. We also use noninvasive Doppler ultrasound velocimetry study and MDCT coronary angiography to detect the graft patency and evaluate the 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 transient atrial fibrillation. Follow-up study of patients revealed no graft failure or IMA malperfusion in either group (mean follow-up of 10.8 years).
CONCLUSIONS: Long-term follow-up show comparable graft patency results with conventional MIDCAB.
CLINICAL IMPLICATIONS: Lengthening of IMA conduit with SVG segments can be safely performed in MIDCAB when limited exposure will impede adequate IMA harvesting and arterial interposition graft is contraindicated.
DISCLOSURE: The following authors have nothing to disclose: Tsung Tsai, Jung Yu, Yi Wu, Hao Tsai
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