Advertisement

Long-Term Results of Internal Thoracic Artery Grafting

  • J. F. SabikIII
  • F. D. Loop
Chapter

12.6 Conclusions

After nearly four decades of coronary artery bypass surgery, internal thoracic artery grafts have proven to be the best conduit for revascularization. They are resistant to arteriosclerosis and have excellent and stable long-term patency. Use of the left internal thoracic artery to revascularize the left anterior descending improves both long-term survival and freedom from cardiac events. The survival benefit of internal thoracic artery grafting increases with time, and patient-related factors, such as age, gender, and left ventricular dysfunction, do not decrease this benefit. Internal thoracic artery grafting of the left anterior descending should be an integral part of nearly all surgical coronary revascularizations.

Use of two internal thoracic artery grafts inmyocardial revascularization further improves long-term outcomes of coronary artery bypass surgery. All patients do not benefit equally or at the same postoperative time, however. The survival benefit in high-risk patients appears sooner after surgery than in low-risk patients. Studies show that not all bilateral internal thoracic artery revascularization strategies are equally effective in improving the long-term outcomes of coronary revascularization, and using the internal thoracic arteries to graft the two most important left-sided coronary arteries may be preferable.

Keywords

Internal Mammary Artery Internal Thoracic Artery Artery Graft Left Internal Thoracic Artery Bilateral Internal Thoracic Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Vineberg AM (1946) Development of an anastomosis between the coronary vessels and a transplanted internal mammary artery. Can Med Assoc J 55:117–1190PubMedGoogle Scholar
  2. 2.
    Vineberg A, Buller W (1955) Technical factors which favor mammary-coronary anastomoses. J Thorac Surg 30:411–435PubMedGoogle Scholar
  3. 3.
    Bhayana JN, Gage AA, Takaro T (1980) Long-termresults of internal mammary artery implantation for coronary artery disease: a controlled trial. Ann Thorac Surg 29:234–242PubMedCrossRefGoogle Scholar
  4. 4.
    Tector AJ, Kress DC, Downey FX, Schmahl TM (1996) Complete revascularization with internal thoracic artery grafts. Semin Thorac Cardiovasc Surg 8:29–41PubMedGoogle Scholar
  5. 5.
    Kolessov VI (1967) Mammary artery-coronary artery anastomosis as a method for treatment of angina pectoris. J Thorac Cardiovasc Surg 54:535–544PubMedGoogle Scholar
  6. 6.
    Green GE, Stertzer SH, Reppert EH (1968) Coronary arterial bypass grafts. Ann Thorac Surg 5:443–450PubMedCrossRefGoogle Scholar
  7. 7.
    Cameron A, Kemp HG Jr, Green GE (1986) Bypass surgery with the internal mammary artery graft: 15 year follow-up. Circulation 74(Suppl III):30–36Google Scholar
  8. 8.
    Okies JE, Page US, Bigelow JC, Krause AH, Salomon NW (1984) The left internal mammary artery: the graft of choice. Circulation 70(Suppl I):213–221Google Scholar
  9. 9.
    Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, Golding LAR, Gill CC, Taylor PC, Sheldon WC, Proudfit WL (1986) Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1–6PubMedCrossRefGoogle Scholar
  10. 10.
    Grondin CM, Campeau L, Lesperance J, Enjalbert M, Bourassa MG (1984) Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation 70(Suppl I):208–212Google Scholar
  11. 11.
    Barner HB, Standeven JW, Reese J (1985) Twelve-year experience with internal mammary artery for coronary artery bypass. J Thorac Cardiovasc Surg 90:668–675PubMedGoogle Scholar
  12. 12.
    Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC (1985) Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 89:248–258PubMedGoogle Scholar
  13. 13.
    Tector AJ, Schmahl TM, Janson B, Kallies JR, Johnson G (1981) The internal mammary artery graft: its longevity after coronary bypass. JAMA 246:2181–2183PubMedCrossRefGoogle Scholar
  14. 14.
    Campeau L, Enjalbert M, Lesperance J, Vaislic C, Grondin CM, Bourassa MG (1983) Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation 68(Suppl II):1–7Google Scholar
  15. 15.
    Singh RN, Sosa JA, Green GE (1983) Long-term fate of the internal mammary artery and saphenous vein grafts. J Thorac Cardiovasc Surg 86:359–363PubMedGoogle Scholar
  16. 16.
    Fiore AC, Naunheim KS, Dean P, Kaiser GC, Pennington DG, Willman VL, McBride LR, Barner HB (1990) Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg 49:202–209PubMedCrossRefGoogle Scholar
  17. 17.
    Pick AW, Orszulak TA, Anderson BJ, Schaff HV (1997) Single versus bilateral internal mammary artery grafts: 10-year outcome analysis. Ann Thorac Surg 64:599–605PubMedCrossRefGoogle Scholar
  18. 18.
    Sabik JF, Lytle BW, Blackstone EH, Khan M, Houghtaling PL, Cosgrove DM (2003) Does competitive flow reduce internal thoracic artery graft patency? Ann Thorac Surg 76:1490–1497PubMedCrossRefGoogle Scholar
  19. 19.
    Sabik JF, Lytle BW, Blackstone EH, Houghtaling PL, Cosgrove DM (2005) Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. Ann Thorac Surg 79:544–551PubMedCrossRefGoogle Scholar
  20. 20.
    Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR (1996) Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 28:616–626PubMedCrossRefGoogle Scholar
  21. 21.
    Cheseboro JH, Fuster V, Elveback LR, et al. (1984) Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Eng J Med 310:209–214CrossRefGoogle Scholar
  22. 22.
    Galbut DL, Traad EA, Dorman MJ, DeWitt PL, Larsen PB, Kurlansky PA, Button JH, Ally JM, Gentsch TO (1990) Seventeen-year experience with bilateral internal mammary artery grafts. Ann Thorac Surg 49:195–201PubMedCrossRefGoogle Scholar
  23. 23.
    Lytle BW, Loop FD, Thurer RL, Groves LK, Taylor PC, Cosgrove DM (1980) Isolated left anterior descending coronary atherosclerosis: long-term comparison of internal mammary artery and venous autografts. Circulation 61:869–874PubMedGoogle Scholar
  24. 24.
    Bjork VO, Ivert T, Landou C (1981) Angiographic changes in internal mammary artery and saphenous vein grafts, two weeks, one year and five years after coronary bypass surgery. Scand J Thor Cardiovasc Surg 15:23–30Google Scholar
  25. 25.
    Barner HB, Barnett MG (1994) Fifteen-to twenty-one-year angiographic assessment of internal thoracic artery as a bypass conduit. Ann Thorac Surg 57:1526–1528PubMedCrossRefGoogle Scholar
  26. 26.
    Barner HB, Swartz MT, Mudd JG, Tyras DH (1982) Late patency of the internal mammary artery as a coronary bypass conduit. Ann Thorac Surg 34:408–412PubMedCrossRefGoogle Scholar
  27. 27.
    Sisto T, Isola J (1989) Incidence of atherosclerosis in the internal mammary artery. Ann Thorac Surg 47:884–886PubMedCrossRefGoogle Scholar
  28. 28.
    Sims FH (1983) A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis. Am Heart J 105:560–566PubMedCrossRefGoogle Scholar
  29. 29.
    Ross R, Glomset JA (1976) The pathogenesis of atherosclerosis. N Engl J Med 295:369–376PubMedCrossRefGoogle Scholar
  30. 30.
    Chaikhouni A, Crawford FA, Kochel PJ, Olanoff LS, Halushka PV (1986) Human internal mammary artery produces more prostacyclin than saphenous vein. J Thorac Cardiovasc Surg 92:88–91PubMedGoogle Scholar
  31. 31.
    Luscher TF, Diederich D, Siebenmann R, Lehmann K, Stulz P, von Segesser L, Yang Z, Turina M, Gradel E, Weber E, Buhler FR (1988) Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 319:462–467PubMedCrossRefGoogle Scholar
  32. 32.
    Pearson PJ, Evora PRB, Schaff HV (1992) Bioassay of EDRF from internal mammary arteries: implications for early and late bypass graft patency. Ann Thorac Surg 54:1078–1084PubMedCrossRefGoogle Scholar
  33. 33.
    Ivert T, Huttunen K, Landou C, Bjork VO (1988) Angiographic studies of internal mammary artery grafts 11 years after coronary artery bypass grafting. J Thorac Cardiovasc Surg 96:1–12PubMedGoogle Scholar
  34. 34.
    Barner HB (1974) Double internal mammary-coronary artery bypass. Arch Surg 109:627–630PubMedGoogle Scholar
  35. 35.
    Geha AS, Baue AE (1979) Early and late results of coronary revascularization with saphenous vein and internal mammary artery grafts. Am J Surg 137:456–463PubMedCrossRefGoogle Scholar
  36. 36.
    Hashimoto H, Isshiki T, Ikari Y, et al. (1996) Effects of competitive blood flow on arterial graft patency and diameter. Medium-term postoperative follow-up. J Thorac Cardiovasc Surg 111:399–407PubMedCrossRefGoogle Scholar
  37. 37.
    Seki T, Kitamura S, Kawachi K, et al. A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery. J Thorac Cardiovasc Surg 104:1532–1538Google Scholar
  38. 38.
    Pagni S, Storey J, Ballen J, et al. (1997) ITA versus SVG: a comparison of instantaneous pressure and flow dynamics during competitive flow. Eur J Cardiothorac Surg 11:1086–1092PubMedCrossRefGoogle Scholar
  39. 39.
    Shimizu T, Hirayama T, Suesada H, Ikeda K, Ito S, Ishimaru S (2000) Effect of flow competition on internal thoracic artery graft: postoperative velocimetric and angiographic study. J Thorac Cardiovasc Surg 120:459–465PubMedCrossRefGoogle Scholar
  40. 40.
    Pagni S, Storey J, Ballen J, et al. (1997) Factors affecting internal mammary artery graft survival: how is competitive flow from a patent native coronary vessel a risk factor? J Surg Res 71:172–178PubMedCrossRefGoogle Scholar
  41. 41.
    Nasu M, Akasaka T, Okazaki T, et al. (1995) Postoperative flow characteristics of left internal thoracic artery grafts. Ann Thorac Surg 59:154–161PubMedCrossRefGoogle Scholar
  42. 42.
    Morris JJ, Smith LR, Glower DD, Muhlbaier LH, Reves JG, Wechsler AS, Rankin JS (1990) Clinical evaluation of single versus multiple mammary artery bypass. Circulation 82(Suppl IV):214–223Google Scholar
  43. 43.
    Singh RN, Beg RA, Kay EB (1986) Physiological adaptability: the secret of success of the internal mammary artery grafts. Ann Thorac Surg 41:247–250PubMedCrossRefGoogle Scholar
  44. 44.
    Ramstrom J, Lund O, Cadavid E, Oxelbark S, Thuren JB, Henze AC (1993) Right internal mammary artery formyocardial revascularization: early results and indications. Ann Thorac Surg 55:1485–1491PubMedCrossRefGoogle Scholar
  45. 45.
    Rankin JS, Newman GE, Bashore TM, Muhlbaier LH, Tyson GS Jr, Ferguson TB Jr, Reves JG, Sabiston DC Jr (1986) Clinical and angiographic assessment of complex mammary artery bypass grafting. J Thorac Cardiovasc Surg 92:832–846PubMedGoogle Scholar
  46. 46.
    Bical O, Braunberger E, Fischer M, Robinault J, Foiret JC, Fromes Y, Gaillard D, Maribas P, Bouharaoua T, Souffrant G, Vanetti A (1996) Bilateral skeletonizedmammary artery grafting: experience with 560 consecutive patients. Eur J Cardiothorac Surg 10:971–976PubMedCrossRefGoogle Scholar
  47. 47.
    Huddleston CB, Stoney WS, Alford WC Jr, Burrus GR, Glassford DM Jr, Lea JWIV, Petracek MR, Thomas CS Jr (1986) Internal mammary artery grafts: technical factors influencing patency. Ann Thorac Surg 42:543–549PubMedCrossRefGoogle Scholar
  48. 48.
    Chow MST, Sim E, Orszulak TA, Schaff HV (1994) Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted. Circulation 90II:129–132Google Scholar
  49. 49.
    Dietl CA, Benoit CH, Gilbert CL, Woods EL, Pharr WF, Berkheimer MD, Madigan NP, Menapace FJ (1995) Which is the graft of choice for the right coronary and posterior descending arteries? Comparison of the right internal mammary artery and the right gastroepiploic artery. Circulation 92(Suppl II):92–97Google Scholar
  50. 50.
    Tatoulis J, Buxton BF, Fuller JA (1997) Results of 1,454 free right internal thoracic artery-to-coronary artery grafts. Ann Thorac Surg 64:1263–1269PubMedCrossRefGoogle Scholar
  51. 51.
    Cameron A, Davis KB, Green G, Schaff HV (1996) Coronary bypass surgery with internal-thoracic-artery grafts: effects of survival over a 15-year period. N Engl J Med 334:216–219PubMedCrossRefGoogle Scholar
  52. 52.
    Berreklouw E, Schonberger JPAM, Ercan H, Koldewijn EL, de Bock M, Verwaal VJ, van der Linden F, van der Tweel I, Bavinck JH, Bredee JJ (1995) Does it make sense to use two internal thoracic arteries? Ann Thorac Surg 59:1456–1463PubMedCrossRefGoogle Scholar
  53. 53.
    Cameron AAC, Green GE, Brogno DA, Thornton J (1995) J Am Coll Cardiol 25:188–192PubMedCrossRefGoogle Scholar
  54. 54.
    Boylan MJ, Lytle BW, Loop FD, Taylor PC, Borsh JA, Goormastic M, Cosgrove DM (1994) Surgical treatment of isolated left anterior descending coronary stenosis. J Thorac Cardiovasc Surg 107:657–662PubMedGoogle Scholar
  55. 55.
    Lytle BW, Arnold JH, Loop FD, Akhrass R, Houghtaling PL, Blackstone EH, McCarthy PM, Cosgrove PM (2005) Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg (in press)Google Scholar
  56. 56.
    Sergeant P, Blackstone E, Meyns B (1997) Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. Eur J Cardiothorac Surg 12:1–19PubMedCrossRefGoogle Scholar
  57. 57.
    Johnson WD, Brenowitz JB, Kayser KL (1989) Factors influencing long-term (10-year to 15-year) survival after a successful coronary artery bypass operation. Ann Thorac Surg 48:19–25PubMedCrossRefGoogle Scholar
  58. 58.
    Cosgrove DM, Loop FD, Lytle BW, Gill CC, Golding LAR, Gibson C, Stewart RW, Taylor PC, Goormastic M (1985) Determinants of 10-year survival after primary myocardial revascularization. Ann Surg 202:480–490PubMedGoogle Scholar
  59. 59.
    Eleftenaides JA, Tolis G, Levi E, Mills LM, Zaret BL (1993) Coronary artery bypass grafting in severe left ventricular dysfunction: excellent survival with improved ejection fraction and functional state. J Am Coll Cardiol 22:1411–1417CrossRefGoogle Scholar
  60. 60.
    Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Maynard C, et al. (1983) Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 68:785–795PubMedGoogle Scholar
  61. 61.
    Canver CC, Heisey DM, Nichols RD, Cooler SD, Kroncke GM (1998) Long-term survival benefit of internal thoracic artery grafting is negligible in a patient with bad ventricle. J Cardiovasc Surg 39:57–63Google Scholar
  62. 62.
    Lytle BW, Blackstone EH, Loop FD, et al. (1999) Two internal thoracic artery grafts are better than one. J Thorac Cardiovasc Surg 117:855–872PubMedCrossRefGoogle Scholar
  63. 63.
    Lytle BW, Blackstone EH, Sabik JF, Houghtaling P, Loop FD, Cosgrove DM (2004) The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 78:2005–2014PubMedCrossRefGoogle Scholar
  64. 64.
    Stevens LM, Carrier M, Perrault LP, et al. (2004) Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: Effects on mortality and event-free survival. J Thorac Cardiovasc Surg 127:1408–1415PubMedCrossRefGoogle Scholar
  65. 65.
    Buxton BF, Komeda M, Fuller JA, et al. (1998) Bilateral internal thoracic graftingmay improve outcome of coronary artery surgery. Risk adjusted survival. Circulation 98II:1–6Google Scholar
  66. 66.
    Fiore AC, Naunheim KS, Dean P, et al. (1990) Results of internal thoracic artery grafting over 15 years: single versus double grafts. Ann Thorac Surg 49:202–209PubMedCrossRefGoogle Scholar
  67. 67.
    Naunheim KS, Barner HB, Fiore AC (1992) Results of internal thoracic artery grafting over fifteen years: single versus double grafts, 1992 update. Ann Thorac Surg 53:716–718PubMedCrossRefGoogle Scholar
  68. 68.
    Schmidt SE, Jones JW, Thornby JI, Miller CC, Beall AC Jr (1997) Improved survival withmultiple left-sided bilateral internal thoracic artery grafts. Ann Thorac Surg 64:9–15PubMedCrossRefGoogle Scholar
  69. 69.
    Carrel T, Horber P, Turina MI, et al. (1996) Operation for two vessel coronary artery disease: midterm results of bilateral ITA grafting versus unilateral ITA and saphenous vein grafting. Ann Thorac Surg 62:1289–1294PubMedCrossRefGoogle Scholar
  70. 70.
    Pick AW, Orszulak TA, Anderson BJ (1997) Single versus bilateral internal mammary artery grafts: ten-year analysis. Ann Thorac Surg 64:599–605PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • J. F. SabikIII
    • 1
  • F. D. Loop
    • 2
  1. 1.Department of Thoracic and Cardiovascular SurgeryThe Cleveland Clinic FoundationClevelandUSA
  2. 2.Department of Thoracic and Cardiovascular SurgeryThe Cleveland Clinic FoundationLyndhurstUSA

Personalised recommendations