On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

Muhammad Sher-I-Murtaza,Mirza Ahmad Raza Baig

doi:10.12669/pjms.35.3.988

Abstract

Objective:To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery.Methods:The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19.Results:In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424.Conclusions:The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit.

Highlights

Surgical revascularization is an effective treatment modality to treat coronary artery disease
In Coronary Artery Bypass Graft (CABG) surgery, the use of left internal mammary artery (LIMA) to bypass significant left anterior descending (LAD) artery stenosis has been proven by studies as a gold standard clinical practice
All Patients undergoing isolated CABG surgery who were unstable or became unstable at induction of anesthesia or during or after sternotomy were included in the study

Summary

Introduction

Surgical revascularization is an effective treatment modality to treat coronary artery disease. In Coronary Artery Bypass Graft (CABG) surgery, the use of left internal mammary artery (LIMA) to bypass significant left anterior descending (LAD) artery stenosis has been proven by studies as a gold standard clinical practice. These studies have shown that LIMA graft has better long-term patency.[1,2,3] LAD supplies major territory of left ventricle in majority of cases,[4] a graft to LAD. We harvested LIMA in this sub group of patients after establishing cardiopulmonary bypass and used this gold standard conduit to bypass LAD stenosis. Outcome of these patients were studied to analyze safety of this strategy

Methods

Results

Conclusion