Pedicled right internal mammary artery for reoperative off-pump revascularization of left anterior descending coronary artery

Abstract

In situ right internal mammary artery is the graft of choice in reoperative off-pump coronary artery bypass grafting, as well as in primary on-pump coronary artery bypass grafting, unless the vessel has been used previously. However, there are not enough data about postoperative angiographic findings of the in situ right internal mammary artery in reoperative coronary artery bypass grafting with the off-pump technique. From September 1993 through January 2004, we reviewed the postoperative course and the graft patency of 12 selected patients who underwent off-pump coronary artery bypass grafting reoperation only for revascularization of the left anterior descending artery, by means of a pedicled right internal mammary artery graft. All patients were evaluated clinically and by postoperative coronary angiography. There were no early or late deaths during the mean follow-up period of 33.08 +/- 30.05 months (range, 1-77 months). The mean interval from the 1st operation to the 2nd operation was 74.1 +/- 57.01 months (range, 4.5-171 months). Postoperative coronary angiograms of all patients showed a 100% patency rate for both in situ grafts and composite grafts. We suggest that use of the in situ right internal mammary artery in off-pump coronary artery bypass grafting is a safe and reliable option for revascularizing the left anterior descending artery, especially in reoperation.

Fig. 1 Postoperative angiograms. Crossover in situ right internal mammary artery (RIMA) was anastomosed to the left anterior descending coronary artery (LAD).

Fig. 2 Postoperative angiogram. In situ right internal mammary artery (RIMA) was anastomosed to the free radial artery (RA) in end-to-end fashion (composite graft), which revascularized the left anterior descending coronary artery (LAD) in end-to-side fashion.