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Abstract

The left internal thoracic artery (LITA) has become the conduit of choice for myocardial revascularization, because it has been proved that early mortality and morbidity are low.1Barner HB Standeven JW Reese J Twelve-year experience with internal mammary artery for coronary artery bypass.J Thorac Cardiovasc Surg. 1995; 90: 668-675Google Scholar, 2Lytle BW Loop FD Cosgrove DM Ratliff NB Easley K Taylor PC Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts.J Thorac Cardiovasc Surg. 1985; 89: 248-258PubMed Google Scholar, 3Cameron A Davis KP Green G Schaff HV Coronary bypass surgery with internal-thoracic artery grafts effects on survival over a 15-year period.N Engl J Med. 1996; 25: 216-219Crossref Scopus (744) Google Scholar At our institution 98% of all surgical revascularizations of the myocardium are performed with an LITA on the left anterior descending artery (LAD). Perioperative or early postoperative malperfusion of the LITA is a rare complication of coronary artery bypass grafting and may lead to the potentially fatal LITA hypoperfusion syndrome, which is caused by an acute imbalance between myocardial demand and nutritional support through the LITA.4Vajtai P Raviachandran PS Fessler CL Floten HS Ahmad A Gately HL et al.Inadequate internal mammary artery graft as a cause of postoperative ischemia: incidence, diagnosis and management.Eur J Cardiothorac Surg. 1992; 6: 603-608Crossref PubMed Scopus (28) Google Scholar, 5Sarabu MR McClung JA Fass A Reed GE Early postoperative spasm in left internal mammary artery bypass grafts.Ann Thorac Surg. 1987; 44: 199-200Abstract Full Text PDF PubMed Scopus (198) Google Scholar, 6Segesser LV Simonet F Meier B Finci L Faidutti B Inadequate flow after internal mammary coronary artery anastomosis.Thorac Cardiovasc Surg. 1987; 35: 352-355Crossref PubMed Scopus (46) Google Scholar Since we changed the preparation technique of the LITA by using very-low electrocautery and dilatation of the LITA by intraluminal infusion of 1% papaverine solution, the incidence of LITA hypoperfusion syndrome has decreased significantly to 1% in 1997. Recently Pagni and associates7Pagni S Salloum E Storey J Montgomery W Cerrito P Van Himbergen D et al.Double grafting of the left anterior descending artery: Is the distance between the interal mammary artery and supplemental vein graft anastomoses relevant in graft survival?.Eur J Cardiothorac Surg. 1998; 13: 36-41Crossref PubMed Scopus (3) Google Scholar demonstrated on a dog model that the increased distance (3-4 cm) of the additional vein graft implantation to the LITA might be an important factor in maintaining ITA patency. The additional vein graft implantation described in our article was at least 3 cm distal to the LITA implantation performed. Still, and as we do agree with Galea and associates, the additional vein graft to the LAD is the therapy of choice for LITA hypoperfusion syndrome.