LONG-TERM RESULTS OF REOPERATIONS FOR RECURRENT ANGINA WITH INTERNAL MAMMARY ARTERY VERSUS SAPHENOUS-VEIN GRAFTS

Objective-To evaluate the long term results of coronary reoperations f or recurrent angina with internal mammary (thoracic) arteries versus v ein grafts. Design-Inception cohort of 103 patients with a mean follow up of 7.1 years (range 1.0-11.6). Setting-Regional cardiothoracic cen tre. Patients-Among 103 consecutive patients, mean (SD) age 61.8 (9.7) years, who were reoperated for recurrent angina between January 1982 and December 1991, 53 patients had unilateral or bilateral internal ma mmary artery (IMA) grafting supplemented or not with saphenous vein (S V) grafts (group A), and 50 patients underwent reoperative coronary su rgery using SV grafts only (group B). The two groups were comparable i n terms of demographic and clinicopathological data. Measurements and results-Operative mortality was 5.6% (95% confidence interval 4.6 to 6 .6) for group A, and 10% (8.2 to 11.8) for group B (p > 0.05).Probabil ity of freedom from new recurrence of angina was 86% at 5 and 10 years in group A, compared with 56% and 25% respectively in group B (p = 0. 005). Freedom from cardiac events was estimated to be 81% at 5 and 10 years in group A, upsilon 52% and 20% for group B, respectively. Actua rial survival was 95% upsilon 93% at 3 years, 95% upsilon 85% at 5 yea rs, and 88% upsilon 71% at 10 years after reoperation (p > 0.05). Conc lusions-The long term results of IMA are superior to SV grafts in term s of freedom from new recurrence of angina and other cardiac events. T he IMA is thus the conduit of choice in coronary revascularisation.