CORONARY-ARTERY BYPASS-GRAFTING WITH THE INFERIOR EPIGASTRIC ARTERY -MIDTERM CLINICAL AND ANGIOGRAPHIC RESULTS

Between December 1988 and September 1993, 157 patients (141 men, 16 wo men, average age 60.2 years, range 37 to 78 years) underwent a complet e myocardial revascularization with 157 inferior epigastric artery gra fts and 285 internal mammary artery grafts (281 in situ, 4 free grafts ). A total of 543 distal arterial anastomoses (average 3.4, range two to five per patient) were constructed, 376 with the internal mammary a rtery and 167 with the inferior epigastric artery. The inferior epigas tric artery grafts were anastomosed to two left anterior descending, 5 diagonal, 34 circumflex, and 126 right coronary arteries. The indicat ions for the use of the inferior epigastric artery were the unavailabi lity of conventional conduits in 56 patients and a favorable anatomy o r a young age in 101 selected patients. The clinical follow-up average s 31.8 months (range 6 to 62 months). Four patients died early, and th ere were three perioperative nonfatal myocardial infarctions. Eight pa tients required early reoperation for thoracic bleeding (2) or drainag e of an abdominal parietal collection (6). There were four late deaths (2 sudden deaths, 2 noncardiac causes) and one nonfatal myocardial in farction. Angina recurred in nine patients, of whom one required reope ration and three underwent successful percutaneous balloon angioplasty of a native coronary artery (2) or an old saphenous vein graft (1). A n early recatheterization was obtained before discharge (average 11 da ys) in 135 patients: 132 of 135 inferior epigastric artery grafts were patent. Seventy-seven patients underwent a second angiographic restud y 6 to 43 months after the operation. Forty-four of the 48 inferior ep igastric artery grafts restudied within the first postoperative year ( average 8.5 months) were patent, but eight showed a diffuse narrowing. Twenty-eight of the 29 inferior epigastric artery grafts examined ang iographically between 13 and 43 months (average 25 months) were open, and among those 29, 25 were widely patent, perfectly matching the rece iving coronary artery. Most of the occluded or narrowed inferior epiga stric artery grafts were grafted onto coronary arteries with mild sten osis at restudy. Five patients underwent a third angiographic reexamin ation up to 60 months after the operation (average 39 months). All fiv e,inferior epigastric artery grafts were widely patent. The early attr ition rate of the inferior epigastric artery, as for any free arterial graft, is probably the result of both the loss of a true pedicle and the need for constructing an additional proximal anastomosis. The fact that the patency rate of the inferior epigastric artery graft seems t o remain stable beyond 1 year could suggest a good durability in the f uture.