HIGH-DOSE ISOSORBIDE DINITRATE FOR MYOCARDIAL REVASCULARIZATION WITH COMPOSITE ARTERIAL GRAFTS

Background. Composite arterial grafting for myocardial revascularizati on is a surgical technique in which free arterial conduits are proxima lly attached to an in situ internal mammary artery. Methods. Composite arterial grafting was performed in 78 patients with internal mammary artery (n = 24), inferior epigastric artery (n = 21), or radial artery (n = 33) connected to the internal mammary artery. Overall, 254 dista l anastomoses were performed (average number, 3.3 per patient), 225 of which were arterial. All patients were treated postoperatively with h igh-dose isosorbide dinitrate (4 to 20 mg/h for 24 hours). Results. Th e in-hospital mortality rate was 2.6% (2 patients). Early recatheteriz ation studies performed 3 weeks (range, 1 to 20 weeks) after operation in 30 patients demonstrated patency rates of 100%, 93%, and 100% for the composite internal mammary artery, inferior epigastric artery, and radial artery groups, respectively. In addition, two inferior epigast ric artery conduits had major intraluminal constriction. At a mean fol low-up of 20 months (range, 1 to 42 months) all patients are alive, an d all but 2 in the inferior epigastric group (97%) are angina free. Co nclusions. This surgical technique can be safely used. On the basis of our experience, the right internal mammary artery and the radial arte ry are the most suitable conduits for this procedure. High-dose nitrat es given perioperatively prevent spasm and ensure early patency rates. (C) 1997 by The Society of Thoracic Surgeons.