LEFT INTERNAL MAMMARY ELONGATION WITH INFERIOR EPIGASTRIC ARTERY IN MINIMALLY INVASIVE CORONARY SURGERY

Objective: Sometimes the left internal mammary artery (LIMA) is not lo ng enough to reach a too lateral LAD when a left anterior small thorac otomy (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 elon gation with an IEA, 20 patients had single vessel disease, 4 had two v essel 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 (h igh expected run off). Results: All patients had an uneventful recover y. After 315 +/- 104 days from surgery all were asymptomatic. A late d oppler flow assessment, performed in 28 patients, showed a high veloci ty diastolic how in 27. One patient was reoperated on because of graft occlusion 84 days after surgery. An angiography was performed after 8 7.5 +/- 23.3 days in 22 patients. All conduit and anastomoses were pat ent but one, (patency rate 21/22, 95.4%); another showed mild anastomo tical stenosis at the LIMA-IEA junction without clinical signs (perfec t patency rate 20/22, 90.9%). Conclusions: IEA elongation of LIMA is a n alternative strategy to reach a lateral LAD in selected cases; a sat isfying patency rate can be expected, when correct surgical indication s are used. (C) 1997 Elsevier Science B.V.