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The Annals of Thoracic Surgery, Vol 45, 533-536, Copyright © 1988 by The Society of Thoracic Surgeons
RH Zeff, C Kongtahworn, LA Iannone, DF Gordon, TM Brown, SJ Phillips, JR Skinner and M Spector
In 1975, 80 patients undergoing revascularization were prospectively
randomized to receive either a greater saphenous vein (SV) graft (41
patients, Group 1) or a left internal mammary artery (LIMA) graft (39
patients, Group 2) to the left anterior descending coronary artery (LAD).
All patients were completely revascularized. The average number of grafts
per patient in both groups was 3.2. Patients were followed 10 years;
follow-up was 97.5% complete. Group 1 and Group 2 were compared in regard
to mortality, treadmill response, myocardial infarction, reoperation,
percutaneous transluminal coronary angioplasty, and return to work.
Mortality in Group 1 was 17.9% versus 7.7% in Group 2 (p less than 0.05).
Treadmill studies were positive in 17 Group 1 patients and 7 Group 2
patients (p less than 0.05). Myocardial infarctions occurred in 8 patients
in Group 1 versus 3 in Group 2. The number of reoperations was 2 in Group 1
versus 1 in Group 2. Percutaneous transluminal coronary angioplasty was
performed in 3 patients in Group 1 and 2 in Group 2. Repeat studies
revealed 76.3% patency of the SV graft to the LAD (Group 1) and 94.6%
patency of the LIMA graft to the LAD (Group 2). Cardiac-related mortality
in Group 1 was 12.8% at 10 years (5 patients) versus 7.7% in Group 2 (3
patients). Based on this study, the IMA is a superior conduit for bypass to
the LAD.
ARTICLES
Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up
Department of Cardiovascular Medicine and Surgery, Mercy Hospital Medical Center, Des Moines, IA.
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