Sub-optimal Internal Mammary Grafts: Incidence, Timing, and Etiology

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

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Publication Details

Journal
Angiology
Published
2025-02-18
DOI
https://doi.org/10.1177/00033197251320143
Primary Topic
Cardiac and Coronary Surgery Techniques
Type
article
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article

Sub-optimal Internal Mammary Grafts: Incidence, Timing, and Etiology

Mohsin Gondal, Mark Sammut, Alexander Rothman, Stefano Forlani et al.
Angiology
Cardiac and Coronary Surgery Techniques
article

Sub-optimal Internal Mammary Grafts: Incidence, Timing, and Etiology

Mohsin Gondal, Mark Sammut, Alexander Rothman, Stefano Forlani, Julian Gunn, Dwayne Conway, Arfah Hazel Preston, Oliver Glover, Arvindra Krishnamurthy, Zulfiquar Adam, Robert F. Storey, Eron Yones, Steven Hunter, Govind Chetty, David Barmby, Harjinder Kaur, Peter Braidley, Renata Greco, Joseph Kazibwe, Norman Briffa, Ann Cheng, Thomas A Slater, Javaid Iqbal, Paul Morris, J. David Richardson, Kenneth Morgan, Neil Cartwright, J. M. West
article en

Abstract

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

AngiologyVol. 77(3)
Sheffield Teaching Hospitals NHS Foundation Trust (GB), University of Sheffield (GB)
No poverty
Openalex Percentile: Top 95%
Cardiac and Coronary Surgery Techniques
DOISourceOpenAlex
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