Superiority of the internal mammary artery as a coronary bypass graft

Abstract Cardiovascular disease is one of the leading causes of death in the United States, and coronary artery bypass graft surgery (CABG) is one of the mainstays of treatment for this disease (Niklason et al., 1999). Since artificial vascular grafts suitable for coronary bypass are not yet available, the autologous internal mammary artery (IMA) and saphenous vein are used to bypass diseased tissue (Niklason et al., 1999). While IMA grafts have high long-term patency rates, a saphenous vein grafted into the arterial position tends to stenose and eventually thrombose.

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Potent Inhibitory Effect of Sr 49059, An Orally Active Non-Peptide Vasopressin via Receptor Antagonist, on Human Arterial Coronary Bypass Graft

Clinical Science ◽

10.1042/cs0890481 ◽

1995 ◽

Vol 89 (5) ◽

pp. 481-485 ◽

Cited By ~ 5

Author(s):

James J. Liu ◽

Joan R. Chen ◽

Brian B. Buxton ◽

Colin I. Johnston ◽

Louise M. Burrell

Keyword(s):

Receptor Antagonist ◽

Bypass Graft ◽

Coronary Bypass ◽

Inhibitory Effect ◽

V1a Receptor ◽

Mammary Arteries ◽

Coronary Bypass Graft ◽

Internal Mammary ◽

Vasopressin V1a Receptor

1. The effect of vasopressin receptor antagonists varies between analogues (peptide, non-peptide) and across species. In this study the effect of the novel non-peptide vasopressin V1a receptor antagonist SR 49059 on human internal mammary arteries was investigated. 2. SR 49059 produced a potent, concentration-dependent, inhibitory effect on vasopressin-induced contraction of human coronary bypass graft internal mammary arteries. Both SR 49059 (1 μmol/l) and a peptide selective V1a antagonist {[d(CH2)5sarcosine7]arginine vasopressin} (1 μmol/l) abolished vasopressin-induced contraction. The non-peptide V1a receptor antagonist OPC-21268 (1 μmol/l) had no effect on vasopressin-induced contraction. 3. The effect of SR 49059 was specific to vascular vasopressin receptors as noradrenaline-induced contraction was not influenced by SR 49059. 4. The results of this study in vitro indicate that the non-peptide SR 49059 is a potent, specific vasopressin V1a receptor antagonist in the human internal mammary artery and suggest that it may be a useful tool for studying the pathophysiological role of vasopressin in man.

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A New Current to The Armamentarium: Is the CHA2DS2-Vasc-HS Score Predictive of Low Left Internal Mammary Artery (LIMA) Flow in Patients Underwent Coronary Bypass Surgery?

The Heart Surgery Forum ◽

10.1532/hsf.3837 ◽

2021 ◽

Vol 24 (4) ◽

pp. E631-E636

Author(s):

Nihat SOYLEMEZ ◽

Mehmet BALLI ◽

Fatma KÖKSAL ◽

Mahmut YILMAZ ◽

Fazilet ERTURK SAG ◽

...

Keyword(s):

Bypass Surgery ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Bypass Graft ◽

Previous History ◽

Estimation Method ◽

Coronary Bypass ◽

Internal Mammary ◽

Flow Group ◽

Artery Disease

Introduction: Left internal mammary artery (LIMA) grafts should be used in patients undergoing CABG. No other procedure results in patency equivalent to that of the left anterior descending coronary artery (LAD)–LIMA bypass graft. The CHA2DS2-Vasc-HS scoring system can be used to successfully predict CAD severity in stable CAD patients. We aimed to investigate the relationship between LIMA flow and the CHA2DS2-Vasc-HS score. Methods: A total of 684 patients, who underwent CABG surgery, were included in this study. Previous history of bypass surgery, emergency operations, patients with Leriche syndrome and patients with severe obstructive pulmonary and subclavian artery disease were excluded from our study. Patients with a LIMA flow that was suitable for bypass grafting, as determined during the intraoperative evaluation, were included in the low LIMA flow group, and the CHA2DS2-Vasc-HS score was calculated for all patients. Results: Patients in the low LIMA flow group (Group 1) were older. The CHA2DS2-Vasc-HS score (P < 0.001), presence of mild or moderate COPD (P = 0.022), number of severely diseased vessels (P = 0.036), and BMI (P < 0.001) were independent predictors of poor LIMA flow. The cutoff value of the CHA2DS2-VASc-HS score for the prediction of poor LIMA flow was >5.5, with a sensitivity of 92.9% and specificity of 83.4% (AUC: 0.938, 95% Cl: 0.906 – 0.970, P < 0.001). Conclusion: A preoperative high CHA2DS2-Vasc-HS score can be used to predict low intraoperative LIMA flow. The CHA2DS2-Vasc-HS score is an easy-to-use and reliable estimation method and can be used as an additional preoperative of LIMA flow in patients undergoing CABG due to severe CAD.

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Biology of bypass vessels and their relation to patency and disease

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0008 ◽

2021 ◽

pp. 23-30

Author(s):

Thomas F. Lüscher

Keyword(s):

Coronary Artery ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Bypass ◽

Artery Bypass Graft ◽

Bypass Grafts ◽

Current Standard ◽

Internal Mammary ◽

The Right

Current standard surgical technique in patients undergoing coronary bypass grafting involves the use of an internal mammary artery (also known as an internal thoracic artery) bypass graft, in general to the left anterior descending coronary artery, and in many centres also the use of the right internal mammary artery to the right coronary artery. Several clinical studies have shown the superiority of mammary artery bypass grafts for survival of patients compared to the use of venous bypass grafts alone. Indeed, the internal mammary artery has several biological features, discussed in this chapter, that are remarkable and of great interest for biologists, cardiologists, and surgeons alike.

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