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  • Title: [Revascularization of the left coronary system with both internal mammary arteries in disease of the left main artery].
    Author: Antunes PE, Oliveira JF, Franco CG, Antunes MJ.
    Journal: Rev Port Cardiol; 1996 Jan; 15(1):19-24. PubMed ID: 8703500.
    Abstract:
    Although the longterm patency of the internal mammary artery (IMA) has been clearly demonstred, some doubts have been cast as to the perioperative adequacy of its flow. Hence, the sole use of these conduits in patients with left main disease (LMD) has been cautioned. To clarify the significance of this problem in our own population, we have considered in this study, 110 patients with significant LMD subjected to isolated myocardial revascularization from November 1992 trough November 1994. These patients were retrospectively divided into two Groups based on the type of revascularization of the left coronary territory: Group I-35 patients (mean age 51.8 +/- 6.0 years) in whom both the left anterior artery and branches of the circunflex artery were grafted with the left and right IMAs, respectively; and Group II-85 patients (mean age 63.9 +/- 7.7 years) in whom the anterior descending artery received the left IMA and the circunflex system received saphenous vein grafts. No patient in Group I received venous grafts in the left coronary system and in four patients of Group II the rigth IMA was anastomosed to the right coronary artery. The operative mortality was 0% in Group I and 3.5% in Group II (p = NS). The rate of perioperative myocardial infarction was 2.9% and 2.3%, respectively. The incidence of other complications was also similar in the two groups with regards to the need for inotropes (8.6% in the Group I and 7.0% in group II), and the prevalence of arrhythmias (22.8% and 23.5%) but was marginally higher in Group I with regards to reoperation for haemorrhage (8.6% and 3.5%) and sternal dehiscence (5.7% and 2.3%). The mean time of hospital admission was 8.3 days for both groups. The use of both IMAs as the sole conduits for revascularization of the left coronary system in patients with LMD did not increased surgical risk. Also, the hypothesis of insufficient blood flow to the myocardium does not appear to be supported by this study.
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