Internal mammary artery bypass: effect on longevity and recurrent angina pectoris in 2900 patients

• Published in: European journal of cardio-thoracic surgery Vol. 3; no. 4; pp. 321 - 325
• Main Authors: ACINAPURA, A. J, ROSE, D. M, CUNNINGHAM, J. N, JACOBOWITZ, I. J, KRAMER, M. D, ZISBROD, Z
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 1989; Elsevier Science
• Subjects: Angina Pectoris - diagnosis; Biological and medical sciences; Cardiology. Vascular system; Coronary Disease - mortality; Coronary Disease - surgery; Coronary heart disease; Female; Heart; Humans; Internal Mammary-Coronary Artery Anastomosis; Life Expectancy; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Recurrence; Time Factors; Human; Recurrence; Coronary artery; Surgical anastomosis; Cardiovascular disease; Angina pectoris; Long term; Survival; Aortocoronary; Bypass; Surgery; Internal mammary artery; Comparative study
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/1010-7940(89)90030-4

Internal mammary artery bypass (IMA) to the anterior descending coronaryartery was performed in 2900 patients from January 1978 to December 1987.The average age of the patients was 64 years. Males accounted for 68% (1972patients) and 82% (2378 patients) were in New York Heart Association (NYHA)class III. Left ventricular function was impaired in 51%. The averagenumber of additional saphenous vein grafts per patient was 1.8. Theoperative mortality was 1.6%. Mediastinitis occurred in 29 patients (1%).Reoperation for bleeding was necessary in 32 patients (1.1%). Perioperativemyocardial infarction (MI) was seen in 58 patients (2%) and neurologicalcomplications occurred in 32 patients (1.1%). Repeat coronary angiographywas performed in 703 patients (25%) and demonstrated a patency rate of 96%in IMA grafts and 81% in saphenous vein grafts (SVG). Survival at 9 yearswas 90% from all causes and 95% when noncardiac deaths were excluded.Recurrence of angina occurred in 522 patients (18%) and reoperation wasperformed in 15 patients (0.5%). During the same time period, 1783 patientsunderwent coronary artery bypass utilizing a SVG. Survival at 9 years was78% from all causes and 83% when noncardiac deaths were excluded. Recurrentangina was present in 546 patients (39%). These data suggest that apatent-IMA to the anterior descending protects against recurrent angina anddeath from cardiac causes and should be the conduit of choice.