Results of internal mammary artery-coronary artery bypass surgery and the characteristics of internal mammary artery grafts.
抄録
Coronary artery bypass grafting utilizing the internal mammary artery (IMA) was performed in 108 patients with an operative mortality (less than 1 month) of 0% and a hospital mortality of 1.9%. The IMA was used most often in the left anterior descending artery system in combination with saphenous vein grafts (SVG) to the right and left circumflex artery systems. Although the IMA flow was smaller than the SVG flow when measured intraoperatively by an electromagnetic flow meter, postoperative clinical, electrocardiographic, isotopic, angiographic and coronary sinus flow-metric studies all demonstrated that the IMA can respond well to myocardial blood flow demand both at rest and during exercise, resulting in excellent clinical improvements with no detectable signs of flow deficiency. In addition, no signs of ischemia were detected in any of the 15 patients with stenosis in the left main trunk treated with an IMA graft. The IMA graft appears to have a great adaptive capacity to meet increased myocardial demand. Postoperative angiography performed at an average of 3 months after surgery in 60 unselected patients demonstrated an IMA patency rate of 98% in comparison with 88% patency in SVGs to the left anterior descending artery (p<0.05). Not only the patency rate, but also the graft wall characteristics were much better in IMA grafts than in SVGs. Some SVGs showed marked wall irregularity as early as 3 months after surgery. Postoperative changes in the IMA caliber (enlargement when the run-off is great) and the lower rate of progression of stenosis in the native recipient coronary artery receiving an IMA graft have led us to conclude that the IMA graft is a "living conduit" with great adaptive capacity, acting like a very large collateral vessel created by surgery: it responds well to coronary blood flow demand in a cooperative manner with native coronary artery flow and also shows good potential for long-term patency.
収録刊行物
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- JAPANESE CIRCULATION JOURNAL
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JAPANESE CIRCULATION JOURNAL 51 (9), 1052-1060, 1987
社団法人 日本循環器学会
