title: High-dose isosorbide dinitrate for myocardial revascularization with composite arterial grafts.
abstract: BACKGROUND
  Composite arterial grafting for myocardial revascularization is a surgical technique in which free arterial conduits are proximally attached to an in situ internal mammary artery.
  
  
  METHODS
  Composite arterial grafting was performed in 78 patients with internal mammary artery (n = 24), inferior epigastric artery (n = 21), or radial artery (n = 33) connected to the internal mammary artery. Overall, 254 distal anastomoses were performed (average number, 3.3 per patient), 225 of which were arterial. All patients were treated postoperatively with high-dose isosorbide dinitrate (4 to 20 mg/h for 24 hours).
  
  
  RESULTS
  The in-hospital mortality rate was 2.6% (2 patients). Early recatheterization studies performed 3 weeks (range, 1 to 20 weeks) after operation in 30 patients demonstrated patency rates of 100%, 93%, and 100% for the composite internal mammary artery, inferior epigastric artery, and radial artery groups, respectively. In addition, two inferior epigastric artery conduits had major intraluminal constriction. At a mean follow-up of 20 months (range, 1 to 42 months) all patients are alive, and all but 2 in the inferior epigastric group (97%) are angina free.
  
  
  CONCLUSIONS
  This surgical technique can be safely used. On the basis of our experience, the right internal mammary artery and the radial artery are the most suitable conduits for this procedure. High-dose nitrates given perioperatively prevent spasm and ensure early patency rates.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Ichilov Hospital, Elias Sourasky Tel-Aviv Medical Center, Tel-Aviv University, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Gurevitch
authors.forename: H I
authors.initials: HI
authors.lastname: Miller
authors.forename: I
authors.initials: I
authors.lastname: Shapira
authors.forename: A
authors.initials: A
authors.lastname: Kramer
authors.forename: Y
authors.initials: Y
authors.lastname: Paz
authors.forename: M
authors.initials: M
authors.lastname: Matsa
authors.forename: R
authors.initials: R
authors.lastname: Mohr
authors.forename: V
authors.initials: V
authors.lastname: Yakirevich
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001158:Arteries; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D017534:Radial Artery / Q000637:transplantation; D013270:Stomach / Q000098:blood supply; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D007548:Isosorbide Dinitrate