Left internal mammary elongation with inferior epigastric artery in minimally invasive coronary surgery

OBJECTIVE: Sometimes the left internal mammary artery (LIMA) is not long enough to reach a too lateral LAD when a left anterior small thoracotomy (LAST operation) is the surgical approach to graft the LAD. LIMA elongation with an inferior epigastric artery (IEA) can be an useful surgical option. METHODS: From November 1994 to June 30, 1996, out of 289 patients who underwent LAST operation; 28 patients had a LIMA elongation with an IEA, 20 patients had single vessel disease, 4 had two vessel disease, and 4 three vessel disease. Mean age was 62 +/- 22 (48-84) and mean EF was 57 +/- 86. The IEA was used only when the LAD was totally or nearly occluded with no transmural myocardial infarction (high expected run off). RESULTS: All patients had an uneventful recovery. After 315 +/- 104 days from surgery all were asymptomatic. A late doppler flow assessment, performed in 28 patients, showed a high velocity diastolic flow in 27. One patient was reoperated on because of graft occlusion 84 days after surgery. An angiography was performed after 87.5 +/- 23.3 days in 22 patients. All conduit and anastomoses were patent but one, (patency rate 21/22, 95.4%); another showed mild anastomotical stenosis at the LIMA-IEA junction without clinical signs (perfect patency rate 20/22, 90.9%). CONCLUSIONS: IEA elongation of LIMA is an alternative strategy to reach a lateral LAD in selected cases; a satisfying patency rate can be expected, when correct surgical indications are used.