Considerations in the use of autogenous venous grafts for myocardial revascularization.

SUCCES SFUL REVASCULARIZATION OF the anterior left ventricle in patients suffering from coronary artery disease has been achieved by implantation of the internal mammary artery (Vineberg operation) .'' An extension of this procedure to include epicardiectomy, seropericardiec-tomy and free omental grafting (Vineberg procedure) has been proposed on the basis of increased survival following experimental occlusion of the coronary arteries.'0 The need for total myocardial revascularization is substantiated by selective cine coronary arteriographic studies which show posterior myocardial ischemia and combined anterior and posterior myocardial ischemia in more than 75 per cent of the patients with significant coronary artery disease.3 Implantation of a vessel into the posterior left ventricular myocardium should affect the same beneficial result as the internal mammary implanted anteriorly. Grafting of an autogenous vein between the descending thoracic aorta and the anterior myocardium has been employed experimentally and clinically.2' " Total experimental myocardial revascularization using an autogenous venous graft to the posterior myocardium combined with the Vineberg procedure constitutes the basis of this report. METHODS AND MATERIALS Adult mongrel dogs weighing 18 to 22 kg were anesthetized with sodium pento-barbital, intubated and placed on a positive pressure respirator using 100 per cent and the Houston Heart Association. oxygen. The chest was opened through a left fifth intercostal incision. The pericar-dium was opened anterior to the phrenic nerve and the left auricular appendage retracted posteriorly to expose the anterior descending and circumflex branches of the left coronary artery. In a group of 25 dogs, ameroid coronary artery constrictors, with an internal diameter of 3 mm, previously boiled in white petroleum jelly for one hour and gas sterilized, were placed on the two branches of the left coronary artery at its bifurcation. Arteri es originating between the anterior descending and circum-flex branches of the left coronary were ligated. In a group of 40 dogs, a third ameroid constrictor was placed on the right coronary artery near its origin. This maneuver was accomplished by elevating the right auricular appendage with an atrau-matic clamp and gently depressing the right ventricle. Revascularization procedure was performed on 20 animals with triple coronary artery ameroid occlusion and on 15 animals with double coronary artery ameroid occlusion. This procedure consisted of: 1) Implantation of the left internal mammary artery into the anterior left ven-tricular myocardium. 2) Seropericardiectomy and epicardiec-tomy. 3) Implantation of an autogenous vein from the descending thoracic aorta to the posterior left ventricular myocardium. …