Document Detail


Long-term outcome of revascularization of the anterior coronary arteries with crossed double internal mammary versus saphenous vein grafts.
MedLine Citation:
PMID:  3498999     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
When simultaneous revascularization of the left anterior descending (LAD) artery and the proximal segments of the diagonal LAD and marginal coronary arteries is required, the direction and location of these vessels allow excellent alignment of the left internal mammary artery (IMA) with the LAD and the right IMA with the diagonal LAD or marginal arteries, an approach originally described in 1976. To analyze and compare the long-term outcome of this approach versus the saphenous vein bypass graft (SVG) approach for anterior coronary revascularization, we reviewed 43 patients who had these crossed double IMAs (CDIMAs) and 53 patients who had SVGs to the same obstructed anterior coronary arteries during 1973 to 1978; 32 patients in the CDIMA group and 43 in the SVG group also had SVGs to other diseased vessels. The two groups had similar demographic and epidemiologic characteristics. The linearized incidence of late cardiac death, reoperation, recurrent angina, and infarction was 0.2%, 0.7%, 1.4%, and 0% per patient-year, respectively, in the CDIMA group, and 1.6%, 2.4%, 7.8%, and 1.8% per patient-year in the SVG group (p less than 0.01 for each event). At 5 years, the actuarial number of patients with CDIMAs free of late cardiac death was 100%, of reoperation 98%, of recurrent angina 98% (p less than 0.01), and infarction 100% (p less than 0.01), versus 94%, 98%, 84%, and 94%, respectively, in the SVG group. At 10 years, the actuarial incidence of all events was substantially and significantly less in patients with CDIMAs. CDIMAs have significantly better prognostic effects than SVGs when revascularization of the anterior coronary arteries is required. This is currently our preferred approach in these selected patients.
Authors:
A S Geha; G L Hammond; R N Stephan; R K Kleiger; R J Krone
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Surgery     Volume:  102     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  1987 Oct 
Date Detail:
Created Date:  1987-10-30     Completed Date:  1987-10-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  667-73     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Case Western Reserve University, School of Medicine, Cleveland, Ohio.
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MeSH Terms
Descriptor/Qualifier:
Actuarial Analysis
Adult
Aged
Angina Pectoris / epidemiology
Coronary Artery Bypass / methods*
Coronary Disease / mortality
Humans
Internal Mammary-Coronary Artery Anastomosis*
Male
Middle Aged
Myocardial Infarction / epidemiology
Prognosis
Recurrence
Saphenous Vein / transplantation*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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