Revascularization of the Circumflex Artery Using Pedicled Right Internal Mammary Artery Graft via the Transverse Sinus

Retro-aortic crossing of the pedicled right internal mammary artery (RIMA) for revascularization of the circumflex artery (Cx) is an attractive technique to achieve complete arterial revascularization of the left ventricle. Patients and
METHODS
Between April 1995 and December 1997, this technique was applied to 115 eleeti ve patients (98 males, I 7 females; average age 56.3 years, range 34-75 years). Twenty-three patients were diabetics and ten patients had suffered from chronic obstructive pulmonary disease (COPD). Thirteen had a left ventricular ejection fraction < 40%. The RIMA grafts were passed through the transverse sinus to revascularize the lateral back side of the myocardium. The RIMA graft was anastomosed to the Cx artery (the intermediary artery (IM) in 21, the obtuse marginal artery (OM) in 84, the posterolateral Cx (PLCx) in 10 patients). The left internal mammary artery (LIMA) graft was anastomosed to the LAD in 63, LAD and diagonal in 51 and LAD proximaldistal in one patient. In eight patients, the right gastroepiploic artery (RGEA) was anastomosed to the right coronary artery (RCA) or its branches. In 42 patients complete arterial revascularization had been achieved. Patients received on average, 2.52 arterial anastomoses and mean number of distal anastomoses was 3.2.
RESULTS
There was no early or Iate mortality. Perioperative myocardial infaretion was defined as new electrocardiographic Q waves combined with cardiac enzyme elevation creatine kinase MB fraction. Although it was documented in 4 patients (3.5%) none of them needed an intraaortic balloon pump (IABP) support. Three patients were reoperated for sternal dehiscence who had also COPD. Two patients underwent early reoperation for excessive bleeding. Thirty-five patients enrolled in prospective angiographic study agreed to undergo postoperative angiography (range 1 to 12 months after operation). Thirty-three of the 35 RIMA anastomoses and all of the LIMA anastomoses were patent. Treadmill tests were negative in 93 patients ineluding the two patients who have oceluded RIMA anastomoses. Conelusion: We conelude that bringing RIMA via the transverse sinus for grafting the circumflex area provides gread early patency and elinical results.