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USE OF MAMMARY GLANDS IN BYPASS SURGERIES
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USE OF MAMMARY GLANDS IN BYPASS SURGERIES


Dear Sir/Madam,  I am to undergo triple vessel bypass surgery with in next one week and have options of two surgeons. One surgeon claims to use only mammary glands(both sides) while other one uses one side of the mammory glands and one from the forehand.

Kindly let me know the advantages/disadvanteges of each type of surgery and what is best way of getting operated ?


This discussion is related to Issues with breathing after bypass surgery.
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187666_tn?1331176945
If you look to the right of the screen there is a list of "related expert forums." Click on "Interventional Cardiology." Someone just asked a similar question there (titled - unable to find answers). The doctor answered it very well. Hope it helps.
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367994_tn?1304957193
For a perspective that may help you in making the choice and ask relevant questions that may cause you some concern.
The three main arterial systems are the right descending anterior system, the left descending anterior sys-tem, and the circumflex artery.The graft material is harvested at the same time the sternum is opened and the heart exposed. The grafts of choice are the saphenous vein and the internal mammary artery.

The saphenous vein, used mainly to bypass the distal branches of the right and circumflex coronary arteries, is found just beneath the skin on the inside of the thigh. It is easy to harvest, but can become fibrotic and may shorten over time.

The internal mammary artery, usually used to bypass the left anterior descending artery, is found along the sternum. More demanding to harvest , it is a delicate artery that closely matches the internal diameter of the recipient artery and rarely forms atheromas (plaque).

The limitation of saphenous vein graft durability is evident clinically in the return of symptoms in surgically bypassed patients often within 5 years and increased morbidity that follows.  
–  In contrast to saphenous vein grafts, internal mammary conduits are remarkably resistant to atherosclerosis with 10-year patency (remains open) rates of 80–95%. The internal mammary artery performs best when used to bypass the left anterior descending coronary artery.  
–  Other arterial conduits used today include the radial artery and the inferior epigastric arteries. Thus, it is possible to perform multivessel revascularization without using a saphenous vein graft.

The Cleveland Clinic reported a series of 646 patients who were restudied 48 months after their surgery. They noted that 81% of vein grafts harvested from the legs remained open or patent at that time interval. The patency of internal mammary artery grafts for the same period was 95%. The internal mammary artery is a small artery which is detached from beneath the breast bone and can be used to bypass some of the blocked vessels found on the surface of the heart.

Internal mammary artery graft s remain open 97% of the time. The reason for the superior long-term results of internal mammary artery bypass grafts is because the artery is mobilized for grafting along with the small arteries and veins which feed it, the chest wall fat and muscle.

There are several disadvantages that limit internal mammary artery grafting. One is the technical problem of mobilizing the artery. Secondly, there are only two internal mammary arteries and their length is often not sufficient to reach the back wall of the heart well. A third problem is that flow through the internal mammary artery must be equivalent to the flow in the artery to be grafted. In diabetic patients or patients with severe emphysema or fragile breast bones, the artery may be of poor quality and not suitable for grafting purposes... In diabetic patients or patients with severe emphysema or fragile breast bones, the artery may be of poor quality and not suitable for grafting purposes.
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605628_tn?1221436895
I am a 59 year old male, approaching the 2nd anniversary of my triple CABG.
My chest has continued to be very sore, especially at the end of the day, largely at the base of my sternum and under my left breast.
Upon getting up, bending down or initiating exercise I usually get very lightheaded, so much so that I slow down to regain my homeostasis... I keep moving, very slowly and recover in 5 - 10 minutes and then can continue a fairly vigorous pace.  My legs feel heavy and exhausted during this initial period and my chest feels tight... not painful, but like my skin is too tight.
I underwent a very successful rehab program and restored my heart functioning from "an 84 year old to a 37 year old".
I have had 3 episodes of DVT over 25 years ago and have been taking warfarin for 25 years.
I took lipitor for several years before surgery and have been on Crestor since.
I take a water pill and beta blocker for my high blood pressure.
I am struggling to stay positive; after 2 years I thought I'd be doing much better but am discouraged by the extreme light-headedness and fatigue.
My surgeon used one mammary artery attached and used a section of another for my bypasses.  I had 3 incisions in my legs, I am not sure, but I think they successfully harvested some saphenous vessels too.

I'll appreciate any thoughts any one can share.
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