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An Improved Method of Myocardial Revascularization With a Vascular Implant

An Improved Method of Myocardial Revascularization With a Vascular Implant Abstract THE internal mammary artery inserted into a myocardial tunnel has been shown to provide a significant new blood supply to the heart.1-5 When the operation is performed with the standard technique, however, the initial flow rates are very small and a significant incidence of implant thrombosis occurs.6-7 When the implant remains patent, anastomoses with the coronary arteries develop over the course of several months and the initially low flow rate increases to a substantial volume.6 Relief of intractible angina and the persistence of a patent implant have been reported in a gratifying percentage of patients offered this operation.2,4,5 The operation would be improved if higher initial flow rates were achieved. This would ensure continued patency, aid in the early development of significant implantcoronary anastomoses, and provide more significant extra supply of blood to the myocardium. In a series of experiments directed to this purpose, we have References 1. Vineberg, A.M.: Development of Anastomosis Between Coronary Vessels and Transplanted Internal Mammary Artery , Canad Med Assoc J 55:117, 1946. 2. Bigelow, W.G.; Aldridge, H.E.; and MacGregor, D.C.: Internal Mammary Implantation (Vineberg Operation) for Coronary Heart Disease , Ann Surg 164:457, 1966.Crossref 3. Sewell, W.H., et al: Pedicle Operation for Coronary Insufficiency: Technique and Preliminary Results , J Thorac Cardiov Surg 49:317, 1965. 4. Effler, D.B., et al: Myocardial Revascularization by Vineberg's Internal Mammary Artery Implant: Evaluation of Postoperative Results , J Thorac Cardiov Surg 50:527, 1965. 5. Gorlin, R., and Taylor, W.J.: Selective Revascularization of the Myocardium by Internal Mammary Artery Implant , New Eng J Med 275:283, 1966.Crossref 6. Provan, J.L.; Hammond, G.L.; and Austen, W.G.: Flowmeter Studies of Internal Mammary Artery Function After Implantation Into the Left Ventricular Myocardium , J Thorac Cardiov Surg 52:820, 1967. 7. Brener, B.J., and Warren, R.: Internal Mammary Operations for Relief of Myocardial Ischemia , New Eng J Med 273:479-489, 1965.Crossref 8. Baird, R.J., et al: Replacement of the Deep Veins of the Leg , Arch Surg 89:797, 1964.Crossref 9. Baird, R.J., et al: Myocardial Revascularization With Femoral Artery & Vein Autografts, Canad J Surg, to be published. 10. Dow, P., and Hamilton, W.F. " Circulation ," in Handbook of Physiology , Washington, DC: American Physiological Society, 1963, p 1534. 11. Kirk, E.S., and Honig, C.R.: An Experimental and Theoretical Analysis of Myocardial Tissue Pressure , Amer J Physiol 207:362, 1964. 12. Hammond, G.L.; Provan, J.L.; and Austen, W.G.: Experimental Evaluation of Myocardial Revascularization Procedures , Ann Surg 164:951, 1966.Crossref 13. Vineberg, A.M.: Revascularization of the Entire Heart by Internal Mammary Artery Implantation, Epicardectomy and Free Omental Graft , Canad Med Assoc J 94:378, 1966. 14. Diethrich, E.B.; Liddicoat, J.; and Wessinger, J.: Aorto-Myocardial Autogenous Vein Grafts , Arch Surg 90:657, 1965.Crossref 15. Schuldt, H.H., and Krause, H.: Coronary Inflow After Systemic-to-Coronary Artery Anastomosis in Dogs , Amer Heart J 72:359, 1966.Crossref 16. Kantrowitz, A., and Kantrowitz, A.: Experimental Augmentation of Coronary Flow by Retardation of the Arterial Pressure Pulse , Surgery 34:678, 1953. 17. Lopez-Belio, M., et al: Effects of Continuous Flow Through Implanted Mammary Artery and Myocardial Ischemia on Mammary-Coronary Communications , J Thorac Cardiov Surg 42:648, 1961. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

An Improved Method of Myocardial Revascularization With a Vascular Implant

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1967.01330170032005
Publisher site
See Article on Publisher Site

Abstract

Abstract THE internal mammary artery inserted into a myocardial tunnel has been shown to provide a significant new blood supply to the heart.1-5 When the operation is performed with the standard technique, however, the initial flow rates are very small and a significant incidence of implant thrombosis occurs.6-7 When the implant remains patent, anastomoses with the coronary arteries develop over the course of several months and the initially low flow rate increases to a substantial volume.6 Relief of intractible angina and the persistence of a patent implant have been reported in a gratifying percentage of patients offered this operation.2,4,5 The operation would be improved if higher initial flow rates were achieved. This would ensure continued patency, aid in the early development of significant implantcoronary anastomoses, and provide more significant extra supply of blood to the myocardium. In a series of experiments directed to this purpose, we have References 1. Vineberg, A.M.: Development of Anastomosis Between Coronary Vessels and Transplanted Internal Mammary Artery , Canad Med Assoc J 55:117, 1946. 2. Bigelow, W.G.; Aldridge, H.E.; and MacGregor, D.C.: Internal Mammary Implantation (Vineberg Operation) for Coronary Heart Disease , Ann Surg 164:457, 1966.Crossref 3. Sewell, W.H., et al: Pedicle Operation for Coronary Insufficiency: Technique and Preliminary Results , J Thorac Cardiov Surg 49:317, 1965. 4. Effler, D.B., et al: Myocardial Revascularization by Vineberg's Internal Mammary Artery Implant: Evaluation of Postoperative Results , J Thorac Cardiov Surg 50:527, 1965. 5. Gorlin, R., and Taylor, W.J.: Selective Revascularization of the Myocardium by Internal Mammary Artery Implant , New Eng J Med 275:283, 1966.Crossref 6. Provan, J.L.; Hammond, G.L.; and Austen, W.G.: Flowmeter Studies of Internal Mammary Artery Function After Implantation Into the Left Ventricular Myocardium , J Thorac Cardiov Surg 52:820, 1967. 7. Brener, B.J., and Warren, R.: Internal Mammary Operations for Relief of Myocardial Ischemia , New Eng J Med 273:479-489, 1965.Crossref 8. Baird, R.J., et al: Replacement of the Deep Veins of the Leg , Arch Surg 89:797, 1964.Crossref 9. Baird, R.J., et al: Myocardial Revascularization With Femoral Artery & Vein Autografts, Canad J Surg, to be published. 10. Dow, P., and Hamilton, W.F. " Circulation ," in Handbook of Physiology , Washington, DC: American Physiological Society, 1963, p 1534. 11. Kirk, E.S., and Honig, C.R.: An Experimental and Theoretical Analysis of Myocardial Tissue Pressure , Amer J Physiol 207:362, 1964. 12. Hammond, G.L.; Provan, J.L.; and Austen, W.G.: Experimental Evaluation of Myocardial Revascularization Procedures , Ann Surg 164:951, 1966.Crossref 13. Vineberg, A.M.: Revascularization of the Entire Heart by Internal Mammary Artery Implantation, Epicardectomy and Free Omental Graft , Canad Med Assoc J 94:378, 1966. 14. Diethrich, E.B.; Liddicoat, J.; and Wessinger, J.: Aorto-Myocardial Autogenous Vein Grafts , Arch Surg 90:657, 1965.Crossref 15. Schuldt, H.H., and Krause, H.: Coronary Inflow After Systemic-to-Coronary Artery Anastomosis in Dogs , Amer Heart J 72:359, 1966.Crossref 16. Kantrowitz, A., and Kantrowitz, A.: Experimental Augmentation of Coronary Flow by Retardation of the Arterial Pressure Pulse , Surgery 34:678, 1953. 17. Lopez-Belio, M., et al: Effects of Continuous Flow Through Implanted Mammary Artery and Myocardial Ischemia on Mammary-Coronary Communications , J Thorac Cardiov Surg 42:648, 1961.

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1967

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