CORONARY REOPERATION - RESULTS OF ADDING AN INTERNAL MAMMARY ARTERY GRAFT TO A STENOTIC VEIN GRAFT

Although it is desirable at coronary reoperation to replace a stenotic vein graft to the left anterior descending coronary artery (LAD) with an internal mammary artery (IMA) graft, previous reports have shown t hat if the stenotic Vein graft is removed, that strategy can be compli cated by severe hemodynamic deterioration and increased perioperative mortality. We report the results for 90 patients in whom an IMA was us ed to graft a completely obstructed LAD with the stenotic vein graft l eft intact. For 10 patients, reoperation involved only an IMA-LAD graf t, and in 80 patients, a second IMA, veins, or both were used to graft other vessels. There were no hospital deaths. One patient had a perio perative myocardial infarction. Follow-up at a mean postoperative inte rval of 58 months documented 11 late deaths (eight cardiac related) an d actuarial 5-year survival of 88%. Twenty-two patients underwent coro nary angiography at a mean postoperative interval of 48 months. The IM A-LAD graft was found to be perfectly patent in 20 and obstructed in 2 . The strategy of adding an IMA graft to the LAD and leaving a stenoti c vein graft intact has been associated with a low risk of perioperati ve myocardial infarction, the late clinical results are favorable, and repeat angiography indicates that serious competitive now from the st enotic vein graft is uncommon.