What question did this study set out to answer?

To identify the incidence of internal mammary artery (IMA) malperfusion syndrome, assess the efficacy of additional saphenous vein grafting, and evaluate long-term graft patency via angiography.

January 1, 1995European Journal of Cardio-Thoracic Surgery

The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification

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Why the study?

What are the clinical and angiographic outcomes of additional saphenous vein grafting to the distal LAD in patients with acute internal mammary artery malperfusion syndrome?

Population

45 patients with a perioperative course suggesting acute internal mammary artery malperfusion syndrome…

Design

Case_series

Follow-up

3 to 24 months

Authors

TCT CarrelHerzgefäss Medizin Klinik Im Park TKTomasz KujawskiSpitalzentrum Centre hospitalier Biel- Bienne GZGregor ZündBrigham and Women's Hospital

Discussion

Member takes

Implication

Additional SVG to distal LAD may be considered in acute IMA malperfusion; case-level data leave open need for prospective validation.

Key Points

To identify the incidence of internal mammary artery (IMA) malperfusion syndrome, assess the efficacy of additional saphenous vein grafting, and evaluate long-term graft patency via angiography.
Analyzed 2,326 consecutive patients undergoing isolated myocardial revascularization, with 91.3% (2,125/2,326) receiving an IMA graft to the left anterior descending (LAD) coronary artery.
Treated all 45 patients (1.9%) with suspected IMA malperfusion by placing an additional saphenous vein graft to the distal LAD during normothermic ventricular fibrillation.
Conducted follow-up coronary angiography in all 43 surviving patients between 3 and 24 months postoperatively.
Perioperative complications included a hospital mortality of 4.4% (2/45), requirement of intra-aortic balloon pumping in 15.5% (7/45), and anterior myocardial infarction in 28.8% (13/45).
Angiography in survivors demonstrated patent IMA and saphenous vein grafts in 91% of patients (wide patent IMA in 56% [24/43] and narrowed patent IMA in 35% [15/43]).
Vein graft patency with a non-visualized IMA occurred in 7% (3/43), and dual graft failure occurred in 2.4% (1/43) due to severe peripheral LAD disease.

Structured PICO

What are the clinical and angiographic outcomes of additional saphenous vein grafting to the distal LAD in patients with acute internal mammary artery malperfusion syndrome?

Population

45 patients with a perioperative course suggesting acute internal mammary artery (IMA) malperfusion syndrome, identified from a consecutive series of 2,326 isolated myocardial revascularizations.

Intervention

Additional saphenous vein graft to the distal segment of the left anterior descending branch (LAD) performed during normothermic ventricular fibrillation.

Outcome

Hospital mortality, requirement for intra-aortic balloon pumping, anterior myocardial infarction, and angiographic patency of grafts.hard clinical

In acute IMA malperfusion syndrome, an additional saphenous vein graft to the distal LAD is an effective treatment, with early and late postoperative IMA flow to the LAD maintained in the majority of patients.

Cite This Study

Carrel et al. (1995) studied this question.

synapsesocial.com/papers/69effa14bce9831ba4f7398a https://doi.org/10.1016/s1010-7940(05)80143-5

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The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

The internal mammary artery malperfusion syndrome: incidence, treatment and angiographic verification

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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