Arterial Grafting for Myocardial Revascularization

1 Introduction.- 2 Myocardial Revascularization and the Internal Mammary Artery.- 2.1 History of Myocardial Revascularization.- 2.2 Indications for Surgical Coronary Artery Revascularization Today.- 2.3 Early and Late Results of Coronary Artery Bypass Grafting: Attrition of Saphenous Vein Grafts.- 3 Anatomy of the Internal Mammary Artery.- 3.1 Normal Anatomy.- 3.1.1 Macroscopic Studies.- 3.1.2 Microscopic Studies.- 3.2 Anatomical Variations.- 4 Pathology of the Internal Mammary Artery and the Subclavian Artery.- 4.1 Angiographic Studies.- 4.2 Microscopic Studies.- 5 Experimental Studies.- 5.1 Flow Studies in Animals.- 5.1.1 Normal Internal Mammary Artery Flow.- 5.1.2 Internal Mammary Artery Flow and Vasoactive Drugs.- 5.1.3 Internal Mammary Artery Flow Under Pathological Hemodynamic Conditions.- 5.1.3.1 Material and Methods.- 5.1.3.2 Results.- 5.1.3.3 Discussion.- 5.2 Physiological and Pathophysiological Basis for the Superiority of Internal Mammary Artery Grafts in Comparison to Saphenous Vein Grafts.- 5.2.1 Internal Mammary Arteries and Prostacyclin Production.- 5.2.2 Endothelium-dependent Relaxations of the Internal Mammary Artery.- 5.2.3 Early Postoperative Changes of Saphenous Vein Grafts.- 5.3 Expanded Use of the Internal Mammary Artery.- 5.3.1 Free Internal Mammary Artery Grafts (Canine Experiments).- 5.3.2 Retrograde Internal Mammary Artery - Coronary Artery Anastomoses (Canine Experiments).- 5.3.2.1 Material and Methods.- 5.3.2.2 Results.- 5.3.2.3 Discussion.- 5.4 Alternative Grafts for Coronary Artery Revascularization.- 5.4.1 Autologous Alternative Graft Materials.- 5.4.2 Homologous Alternative Graft Materials.- 5.4.3 Biological Substitutes.- 5.4.4 Synthetic Grafts.- 5.4.5 Grafts of the Future.- 6 Clinical Studies.- 6.1 Flow Studies in Humans.- 6.2 Expanded Use of the Internal Mammary Artery in Clinical Coronary Artery Revascularization.- 6.2.1 Sequential Internal Mammary Artery - Coronary Artery Anastomoses.- 6.2.2 Free (Aortocoronary) Internal Mammary Artery Grafts.- 6.2.3 Bilateral Internal Mammary Artery - Coronary Artery Grafting...- 6.2.4 "Prophylactic" Coronary Artery Bypass Grafts.- 7 Clinical Application of Internal Mammary Artery - Coronary Artery Bypass Grafting.- 7.1 Indications for Internal Mammary Artery - Coronary Artery Bypass Grafting.- 7.2 Contraindications for Internal Mammary Artery - Coronary Artery Bypass Grafting.- 7.2.1 Limited Flow in the Early Postoperative Period.- 7.2.2 Increased Intrathoracic Injury.- 7.2.3 More Difficult and Time-Consuming Procedure.- 7.3 Surgical Techniques of Clinical Internal Mammary Artery - Coronary Artery Bypass Grafting.- 7.3.1 Take-Down of the Internal Mammary Arteries.- 7.3.2 Evaluation of the Internal Mammary Artery.- 7.3.3 Cannulation, Cardiopulmonary Bypass and Cardioplegia.- 7.3.4 Internal Mammary Artery - Coronary Artery Anastomoses.- 7.3.4.1 End-to-Side Anastomosis Between the Internal Mammary Artery and the Coronary Arteries.- 7.3.4.2 Sequential Internal Mammary Artery - Coronary Artery Grafting and Side-to-Side Anastomoses.- 7.3.4.3 Internal Mammary Artery - Coronary Artery Y-Anastomoses.- 7.3.4.4 Bilateral Internal Mammary Artery - Coronary Artery Anastomoses.- 7.3.4.5 Maximization of Internal Mammary Artery Length.- 7.3.4.6 Free (Aortocoronary) Internal Mammary Artery Graft Anastomoses.- 7.3.5 Weaning from Cardiopulmonary Bypass.- 7.3.6 Hemostasis.- 7.3.6.1 Autotransfusion.- 7.3.6.2 Preservation and/or Reactivation of Platelets and Coagulation Factors.- 7.3.6.3 Improved Cardiopulmonary Bypass Equipment.- 7.3.7 Drainage.- 7.3.8 Closure of the Pericardial Sac and the Chest.- 8 Results of Internal Mammary Artery - Coronary Artery Bypass Grafting.- 8.1 Early Results.- 8.1.1 Actual Series of Internal Mammary Artery - Coronary Artery Grafting.- 8.1.1.1 Material and Methods.- 8.1.1.2 Results.- 8.1.1.2.1 Preoperative Variables.- 8.1.1.2.2 Operative Variables.- 8.1.1.2.3 Postoperative Variables.- 8.1.1.2.3.1 Mortality.- 8.1.1.2.3.2 Morbidity.- 8.1.1.2.3.3 Follow-up.- 8.1.2 Early Results of Expanded Internal Mammary Artery Grafting in Comparison to Classic Saphenous Vein Grafting.- 8.1.3 Evolution of Perioperative Mortality in Coronary Artery Revascularization.- 8.2 Medium-Term Results of Internal Mammary Artery - Coronary Artery Grafting.- 8.2.1 Patients and Methods.- 8.2.2 Results.- 8.2.3 Comments.- 8.3 Late Results of Internal Mammary Artery - Coronary Artery Grafting.- 9 Complications of Internal Mammary Artery Grafting.- 9.1 Inadequate Flow After Internal Mammary Artery - Coronary Artery Revascularization.- 9.1.1 Patients and Methods.- 9.1.2 Results.- 9.1.3 Comments.- 9.2 Spasms After Coronary Artery Revascularization.- 9.2.1 Coronary Artery Spasm Immediately After Saphenous Vein Grafting.- 9.2.2 Spasm After Internal Mammary Artery Grafting.- 9.3 Mechanical Circulatory Support After Internal Mammary Coronary Artery Grafting.- 9.4 Sternal Infections Following Internal Mammary Artery - Coronary Artery Grafting.- 9.5 Other Complications After Internal Mammary Artery Grafting.- 10 Long Term Follow-up After Internal Mammary Artery - Coronary Artery Revascularization.- 10.1 Freedom From Reinfarction After Coronary Artery Revascularization.- 10.2 Objective Assessment of the Results of Internal Mammary Artery - Coronary Artery Revascularization.- 10.2.1 Scintigraphic Evaluation.- 10.2.2 Angiographic Evaluation.- 10.3 Late Patency Rates of Internal Mammary Artery Grafts.- 11 Redo Coronary Artery Revascularization After Internal Mammary Artery Grafting.- 11.1 Percutaneous Transluminal Angioplasty After Internal Mammary Artery Grafting.- 11.2 Reoperation After Internal Mammary Artery Grafting.- 11.2.1 Completely Occluded Internal Mammary Artery Graft.- 11.2.2 Patent, but Stenosed Internal Mammary Artery Graft.- 11.2.3 Patent, not Stenosed Internal Mammary Artery Graft.- 12 Conclusion.- References.- Suppliers of Material.