title: Left internal mammary elongation with inferior epigastric artery in minimally invasive coronary surgery.
abstract: OBJECTIVE
  Sometimes the left internal mammary artery (LIMA) is not long enough to reach a too lateral LAD when a left anterior small thoracotomy (LAST operation) is the surgical approach to graft the LAD. LIMA elongation with an inferior epigastric artery (IEA) can be an useful surgical option.
  
  
  METHODS
  From November 1994 to June 30, 1996, out of 289 patients who underwent LAST operation; 28 patients had a LIMA elongation with an IEA, 20 patients had single vessel disease, 4 had two vessel disease, and 4 three vessel disease. Mean age was 62 +/- 22 (48-84) and mean EF was 57 +/- 86. The IEA was used only when the LAD was totally or nearly occluded with no transmural myocardial infarction (high expected run off).
  
  
  RESULTS
  All patients had an uneventful recovery. After 315 +/- 104 days from surgery all were asymptomatic. A late doppler flow assessment, performed in 28 patients, showed a high velocity diastolic flow in 27. One patient was reoperated on because of graft occlusion 84 days after surgery. An angiography was performed after 87.5 +/- 23.3 days in 22 patients. All conduit and anastomoses were patent but one, (patency rate 21/22, 95.4%); another showed mild anastomotical stenosis at the LIMA-IEA junction without clinical signs (perfect patency rate 20/22, 90.9%).
  
  
  CONCLUSIONS
  IEA elongation of LIMA is an alternative strategy to reach a lateral LAD in selected cases; a satisfying patency rate can be expected, when correct surgical indications are used.
authors.affiliation: Division of Cardiac Surgery G. D'Annunzio University, S. Camillo de Lellis Hospital, Chieti, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Calafiore
authors.forename: G
authors.initials: G
authors.lastname: Teodori
authors.forename: G
authors.initials: G
authors.lastname: Di Giammarco
authors.forename: G
authors.initials: G
authors.lastname: Vitolla
authors.forename: M
authors.initials: M
authors.lastname: Contini
authors.forename: N
authors.initials: N
authors.lastname: Maddestra
authors.forename: L
authors.initials: L
authors.lastname: Paloscia
authors.forename: A
authors.initials: A
authors.lastname: Iacò
authors.forename: S
authors.initials: S
authors.lastname: Gallina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D015150:Echocardiography, Doppler; D019074:Epigastric Arteries / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012086:Reoperation; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*