Left internal mammary artery usage in coronary artery bypass grafting: a measure of quality control

Abstract

Introduction: Over the last two decades, many studies have shown better long-term patency rates and survival in patients under-going coronary artery bypass grafting (CABG) with left internal mammary artery (LIMA) to the left anterior descending artery (LAD). World-wide, LIMA is accepted as the 'gold standard' for surgical revascularisation and its usage has been steadily increasing.

Patients and methods: Between April 1997 and September 2001, a total of 4406 consecutive patients underwent coronary artery bypass grafting with revascularisation to the left anterior descending artery.

Results: Of the study group, 4047 (91.8%) patients received LIMA to LAD, leaving 359 (8.2%) who did not. Six sub-groups of patients in whom LIMA usage was significantly less were the elderly (> 70 years of age), females, diabetics, patients having emergency CABG, poor left ventricular (LV) function (ejection fraction [EF] < 30%) and patients with respiratory disease.

Conclusions: Although the current focus in the UK is on mortality rates, we believe that it will not be long before this will also include the incidence of major morbidity after CABG such as stroke, myocardial infarction (MI), renal failure and sternal wound problems. We also believe that we should now consider LIMA usage as a marker of quality control after CABG.