Double supply to left anterior descending artery by additional saphenous vein graft in internal thoracic artery malperfusion syndrome.
OBJECTIVE
Internal thoracic artery (ITA) grafting to the left anterior descending artery (LAD) may have catastrophic consequences and can be fatal due to "ITA malperfusion syndrome." We have investigated the efficacy of a second graft in this syndrome.


METHODS
A total of 35 patients, 29 males (82.9%) and 6 females (17.1%), with a mean age of 53.0 +/- 8.7, (range: 38 to 70) undergoing coronary artery bypass grafting required a second supply to LAD due to ITA malperfusion syndrome. This was performed using a saphenous vein graft. The mean number of distal anastomosis was 2.7 +/- 0.45 per patient (range: 1 to 5). The decision for an additional grafting procedure was made in the first operation for 18 patients (51.4%) (Group I). For the remaining 17 patients (48.6%) (Group II), the additional grafting procedures were performed during a reoperation after the development of ischemic complications in the intensive care unit (ICU).


RESULTS
The early mortality rate was 8.6% (3 of 35). Two patients had perioperative myocardial infarction (MI) (5.7%). The second vein graft proved to dramatically reduce the incidence of postoperative MI. Malignant refractory arrhythmias were recorded in 17 patients (48.6%). Twelve patients (34.3%) required inotropic support and seven patients (20%), all in Group II, required intra-aortic balloon pump (IABP) support. The average duration of IABP was 5 days +/- 1.8 days (range: 3 to 7). The necessity of IABP support was found to be statistically higher in the second group compared to the first one.


CONCLUSIONS
Double supply to LAD using an additional saphenous vein graft is the treatment of choice for ITA malperfusion syndrome. The time interval between the first and the second grafts appears to be crucial for postoperative patient outcome.
Sismanoglu
Mesut
M
Kosuyolu Heart and Research Hospital, Istanbul, Turkey. mesut@sismanoglu.com
Bozbuga
Nilgun
N
Ozkaynak
Berk
B
Polat
Adil
A
Erentug
Vedat
V
Akinci
Esat
E
Ipek
Gokhan
G
Balkanay
Mehmet
M
Yakut
Cevat
C
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D016019:Survival Analysis; D013577:Syndrome; D016896:Treatment Outcome