title: Adequate flow through the internal mammary artery graft achieved by a dilatation technique.
abstract: From Jan. 1984 to Dec. 1988 941 patients had internal mammary artery grafting alone or with vein grafts. There were 1705 associated vein grafts and 957 internal mammary grafts, for a total of 2 662 grafts (2.8 per patient). Use of the internal mammary artery was indicated in patients younger than 70 years with a significant stenosis of the main stem or the proximal left anterior descending artery in elective operations. The overall operative mortality was 3.4%, 2.9% for men and 6.2% for women. It rose to 9.6% in patients who were in New York Heart Association Class IV. Incidence of bleeding requiring reexploration was 5.5% and an intra-aortic balloon pump was implanted in 3% because of low cardiac output. At cardiac recatheterization (on average after 12 months) 88.3% of the internal mammary grafts and 63.3% of the vein grafts were patent. In investigation of, reasons for operative mortality, measuring the free flow of the internal mammary artery showed flow rates of 32-208 ml/min only slightly depending on the blood pressure. A technique of dilatation is described that significantly increases the flow rate up to 85%. The technique has been used regularly since Nov. 1987: from that date the IMA is only used if it has a flow rate of at least 60 ml/min.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital, Frankfurt, FRG.
authors.forename: L
authors.initials: L
authors.lastname: Eckel
authors.forename: M
authors.initials: M
authors.lastname: Skupin
authors.forename: R
authors.initials: R
authors.lastname: Schräder
authors.forename: L
authors.initials: L
authors.lastname: Gusic
authors.forename: F
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: K
authors.initials: K
authors.lastname: Sarai
authors.forename: E
authors.initials: E
authors.lastname: Krause
mesh_terms: D003326:Coronary Circulation; D004106:Dilatation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D013997:Time Factors