title: Is the internal thoracic artery the conduit of choice to replace a stenotic vein graft?
abstract: Reoperative coronary artery bypass grafting secondary to saphenous vein graft (SVG) stenosis is a mushrooming problem. The internal thoracic artery graft (ITA) provides superior long-term patency, but its flow is limited and may be inadequate to meet large myocardial demands. To evaluate the efficacy of the ITA as a replacement conduit for a stenotic SVG, 387 consecutive patients undergoing reoperative bypass grafting from 1985 to 1990 with a stenotic SVG to a totally obstructed left anterior descending coronary artery (LAD) were analyzed. The patients were divided into four groups according to the management of the previously placed SVG. Group I (n = 155) underwent graft replacement with a new SVG. Group II (n = 90) received an ITA with the old SVG left intact. In group III (n = 37), an ITA was placed to the LAD with an SVG to the diagonal (old graft interrupted). Group IV (n = 104) had an ITA only to the LAD (old graft interrupted). There were 14 deaths (3.6%). Mortality rate was 7.9% for group IV and 2.1% for groups I through III (p = 0.01). Multivariate analyses identified advancing age (p = 0.001), ITA only (p = 0.001), and female sex (p = 0.04) as independent predictors of operative mortality. Evidence of hypoperfusion in the distribution of the LAD was present in 19 patients, all of whom were in group IV (18.9%). Predictors of hypoperfusion were moderate/severe left ventricular function (p = 0.02) and ITA to the LAD with interruption of the old graft (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Cleveland Clinic Foundation, Ohio 44195.
authors.forename: D
authors.initials: D
authors.lastname: Navia
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: B W
authors.initials: BW
authors.lastname: Lytle
authors.forename: P C
authors.initials: PC
authors.lastname: Taylor
authors.forename: P M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: R W
authors.initials: RW
authors.lastname: Stewart
authors.forename: E R
authors.initials: ER
authors.lastname: Rosenkranz
authors.forename: F D
authors.initials: FD
authors.lastname: Loop
mesh_terms: D002423:Cause of Death; D003251:Constriction, Pathologic / Q000601:surgery; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate