COMPARISON OF SAPHENOUS VEIN GRAFT AND INTERNAL MAMMARY ARTERY TO LEFT DESCENDING ARTERY AFTER CORONARY ENDARTERECTOMY IN CORONARY ARTERY BYPASS GRAFTING PATIENTS FOR DIFFUSE CORONARY ARTERY DISEASE: EARLY POST OPERATIVE OUTCOME

Abstract

Objective: To compare early postoperative outcomes of saphenous vein graft (SVG) and internal mammary artery (IMA) to left anterior descending artery (LAD) after coronary endarterectomy (CE) in coronary artery disease (CAD) patients.

Study Design: Comparative cross sectional study.

Place and Duration of Study: Armed Forces Institute of Cardiology, Rawalpindi Pakistan, from Jan 2018 to Dec 2019.

Methodology: This study was carried out on patients undergoing endarterectomy. They were divided into two groups. Group 1 (n=115) had internal mammary artery grafted to left anterior descending artery and group 2 (n=42) consisted of patients undergoing saphenous vein graft to left anterior descending artery. Data was collected on a specially designed proforma.

Results: Between group 1 internal mammary artery and group-2 saphenous vein graft, mortality was 9% vs. 11% respectively (p-value 0.01) which was statistically significant. Ionotropic score of group 2 was more than group 1 (statistically significant). The difference observed in intra-aortic balloon pump insertion (24% vs. 36%, p=0.08), ventilation time 17.67 ± 26.9 vs. 37.71 ± 62.3, p=0.05), dysrhythmias (24% vs. 21%, p=0.44), duration of inotropic support (90.57 ± 94.7 vs. 101.37 ± 99.6, p=0.53), reopening (14% vs. 14%, p=0.56), intensive care unit stay (109.69 ± 135.4 vs. 136.2 ± 157.3, p=0.30) and hospital stay (07 ± 0.6 vs.
09 ± 0.2, p=0.34) were statistically insignificant.

Conclusion: Internal mammary artery grafting showed better short term results in terms of mortality and ionotropic score and as internal mammary artery graft has a proven long term patency compared to saphenous vein graft, it should be preferred as a conduit whenever possible.