Early Outcomes of Using Skeletonized Left Internal Mammary Artery (LIMA) for Sequential Grafting of Multiple Left Anterior Descending Artery Lesions

Background: In comparison to other arterial and venous conduits, the left internal mammary artery (LIMA) conduit showed superior graft patency and outstanding excellent long-term clinical outcomes. In situ LIMA grafting to the left anterior descending artery (LAD) is believed to be the "gold standard" of coronary revascularization for decades. Objective: We aimed to compare between two surgical methods forgrafting diffusely diseased LAD. Patients and Methods: This retrospective clinical trial was carried out on 80 adult cases with diffuse LAD disease in addition to right coronary artery and left circumflex artery involvement or their branches. They were scheduled for coronary artery bypass grafting (CABG) using the cardiopulmonary bypass in Cardiac Surgery Unit of Elkasr Elaini Medical Centre, cardiothoracic Surgery Department, Cairo University, Cairo, Egypt. Patients were equally classified into two groups (A and B). Results: Incidence of post-operative Myocardial infarction (MI), new onset AF, intra-aortic balloon pump, inotropic support and direct-current shock were significantly lower in group B compared to group A. Spontaneous recovery of sinus rhythm was significantly higher in group B compared to group A. Partial clamp time and aortic cross clamp time were insignificantly different between both groups. Total bypass time, hospital stay, and ICU stay were significantly lower in group B compared to group A. Early mediastinitis and mortality was insignificantly different between both groups. Conclusions: It was proven that LIMA with sequential-jump anastomoses should be utilized to operate LAD diffuse coronary artery lesions and that the surgeon should avoid lengthy arteriotomy with or without endarterectomy + onlay SVG patch with a single long anastomosis due to the elevated risk of early graft occlusion.