[Long-term results with the left internal mammary artery as coronary bypass].

BACKGROUND

From 1986 we have routinely used the left internal mammary artery instead of autologous vein as bypass to the left anterior descending coronary artery.

MATERIAL AND METHODS

A cohort of 52 patients has been followed up for up to 12 years. Six years postoperatively, 40 patients were evaluated by clinical examination, exercise testing and serum lipid assessment. Of these, 38 underwent angiography of the native coronary arteries and of all grafts, which represented 47 left internal mammary artery, 90 saphenous vein, and 3 right internal mammary artery bypasses. Information regarding angina recurrence and the need for repeated revascularisation was obtained from hospital records. Twelve-year mortality data were provided by public registers.

RESULTS

Fifty patients were discharged alive. Two serious complications, of which one was fatal, were directly related to the use of the left internal mammary artery. After six years, all the re-examined patients had improved their exercise tolerance; 25 (63%) were angina-free. 44 (94%) left internal mammary artery and 67 (74%) saphenous vein bypasses were patent. Tobacco consumption was considerably reduced over the first six years postoperatively while mean triglyceride and cholesterol levels remained moderately elevated. After 12 years, 18 patients were deceased, half of them from coronary heart disease.

INTERPRETATION

Our results are in accordance with large, international studies.