Bilateral Internal Mammary Artery Grafts in Patients with Left Main Coronary Artery Disease

David L. Galbut, Ernest A. Traad, Malcolm J. Dorman, Paul L. DeWitt, Parry B. Larsen, Paul A. Kurlansky, Roger G. Carrillo, Thomas O. Gentsch, Brian Galbut, George Ebra

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Abstract

The use of the internal mammary artery (IMA) in myocardial revascularization has been expanded with bilateral and sequential grafting. However, its application in the presence of left main coronary artery stenosis (LMCAS) has not been well established. From September 1983 through December 1990, 280 patients with LMCAS greater than 50% were revascularized (3.4 mean grafts per patient) with bilateral IMA and saphenous vein grafts. Eighty-one were sequential grafts. There were 234 males (83.6%) and 46 females (16.4%) with a mean age of 64.4 years (range 39 to 84 years). Preoperatively, there were six patients (2.1%) in New York Heart Association (NYHA) Class I, 30 patients (10.7%) in Class II, 103 patients (46.4%) in Class III, and 114 patients (40.7%) in Class IV. Fifty-six patients (20.0%) has an ejection fraction less than 50%. Intraaortic balloon counterpulsation was used preoperatively in 26 patients (9.3%) and intraoperatively in 11 patients (3.9%). There were four hospital deaths (1.4%). Hospital complications included: reoperation for bleeding, 7 patients (2.5%); pulmonary insufficiency, 21 patients (7.5%); perioperative infarction, 14 patients (5.0%); and stroke, 4 patients (1.4%). Follow-up was obtained in 276 hospital survivors (100.0%) with a mean of 33.4 months. There were 20 late deaths (7.1%): seven cardiac related and 12 noncardiac related. Postoperative assessment reveals substantial functional improvement. These results furnish evidence that bilateral IMA grafts can be accomplished with a,low operative risk and can provide excellent functional results in patients with LMCAS.

Original languageEnglish (US)
Pages (from-to)18-24
Number of pages7
JournalJournal of cardiac surgery
Volume8
Issue number1
DOIs
StatePublished - Jan 1993

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ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Galbut, D. L., Traad, E. A., Dorman, M. J., DeWitt, P. L., Larsen, P. B., Kurlansky, P. A., Carrillo, R. G., Gentsch, T. O., Galbut, B., & Ebra, G. (1993). Bilateral Internal Mammary Artery Grafts in Patients with Left Main Coronary Artery Disease. Journal of cardiac surgery, 8(1), 18-24. https://doi.org/10.1111/j.1540-8191.1993.tb00572.x