Internal mammary artery grafts: The shortest route to the coronary arteries (original) (raw)

1989, The Annals of Thoracic Surgery

Inadequate length can limit the use of the internal mammary artery (IMA) for coronary revascularization. By following the shortest route from its origin to the recipient coronary artery, IMA use can be maximized. Seven cadavers were studied to determine that shortest route for the left and right IMAs. The shortest route for the left IMA to the left anterior descending coronary, diagonal, and circumflex coronary arteries was through the pericardium (p 5 0.01). For the right IMA, the or coronary artery bypass grafting, the internal mam-F mary artery (IMA) graft carries a greater long-term patency, a decreased need for reoperation, and, perhaps, a decreased recurrence of angina when compared with the saphenous vein graft [l-51. However, the number and length of IMAs limit their use. Numerous methods of extending the use of IMA grafts have been suggested, including augmenting their length by multiply transecting the fascia in the IMA pedicle [6, 71, constructing sequential grafts [7-111, using free IMA grafts by constructing an aorta-IMA anastomosis [7, 11, 121, using both IMAs [7, 9, 13, 141, using both limbs of the IMA beyond its bifurcation [9], gaining length by dissecting the artery well down into the rectus muscle [7], and choosing the shortest route from the IMA origin to the recipient coronary artery [2, 7, 8, 10, 11, 151. This study was designed to find the shortest route for each IMA to each feasible recipient coronary artery. Material and Methods Seven autopsies were performed through the usual Rokitansky incision on 3 men and 4 women. Measurements were made of the patient's weight, height, and sternal lengths, and, on each side, the length of the IMA from its origin to the fifth intercostal space and to the costal margin (Table 1; Fig 1). The pericardium was opened in the midline. Then measurements were made from the origin of the IMA to each of the following feasible coronary arteries: right (RCA), posterior descending (PDA), cicumflex marginal, diagonal, and left anterior descending (LAD). All measurements were made under the following conditions: