title: Efficacy of the internal mammary artery in combined aortic valve replacement-coronary artery bypass grafting.
abstract: BACKGROUND
  While internal mammary artery (IMA) use predicts improved survival after coronary bypass grafting (CABG), it remains unknown whether patients undergoing concomitant aortic valve replacement (AVR) realize a similar benefit.
  
  
  METHODS
  All patients at a single teaching institution, undergoing combined AVR-CABG, which included a graft to the left anterior descending coronary artery (LAD) from 1984 to 1994 (n = 227) were examined retrospectively.
  
  
  RESULTS
  Patients receiving an IMA graft (yesIMA, n = 135) and patients receiving only saphenous vein grafts (nonIMA, n = 92) were not different in their presenting symptoms, or in their incidence of preoperative risk factors. The patients with IMA were more likely to be male, have a later year of operation, be younger, and have a greater body surface. Morbidity was not different between groups. IMA use did not affect 30-day mortality. Long-term actuarial survival was greater in the group with IMA (63% +/- 7% vs 42% +/- 6% at 5 years, p < 0.01). A multivariate Cox proportional hazards model demonstrated that use of an IMA graft improved survival, while recent myocardial infarction, diabetes, earlier year of operation, and lower ejection fraction diminished long-term survival. The relative risk of IMA grafting was 0.570.
  
  
  CONCLUSIONS
  Within the limits of a retrospective analysis, patients in a modern era of cardiac operation, who undergo combined AVR-CABG, do not suffer increased morbidity from IMA use, and may realize a survival benefit from use of the IMA as a conduit for bypass of the LAD coronary artery.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. sagall@ibm.net
authors.forename: S
authors.initials: S
authors.lastname: Gall
authors.forename: J E
authors.initials: JE
authors.lastname: Lowe
authors.forename: W G
authors.initials: WG
authors.lastname: Wolfe
authors.forename: H N
authors.initials: HN
authors.lastname: Oldham
authors.forename: P
authors.initials: P
authors.lastname: Van Trigt
authors.forename: D D
authors.initials: DD
authors.lastname: Glower
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015897:Comorbidity; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies