Sequential Internal Mammary Artery Conduits in Coronary Artery Bypass Grafting
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Bibliographic record
Abstract
The results of sequential internal mammary artery (IMA) grafting in myocardial revascularization, with special emphasis on IMA-related morbidity, have been evaluated over a 2-year period. Between June 1,1991 and July 1,1993,638 patients underwent isolated coronary artery bypass grafting (CABG) at our institution, using the IMA as a conduit. In 541 patients, one or both IMAs were used as a single coronary artery bypass conduit (group 1) and, in the remaining 97 patients, sequential IMA grafting was performed (group 2). The mean age was 60.1 ± 9.2 years and 82% of the patients were male. There were 16.6% repeat CABG in group 1 compared to 3.1% in group 2 (p < 0.01). All patients had preoperative angina and 67% were in the Canadian Cardiovascular Society angina class 3 and 4. Other preoperative patient characteristics were similar in both groups. The overall perioperative mortality was 1.9% (12/638). Twelve patients died in group 1. There were no mortalities in group 2. Nonfatal perioperative myocardial infarction occurred in 10 patients in group 1 (1.6%) and in none in group 2. The incidence of re-exploration for bleeding, sternal wound infections, sternal dehiscence or other perioperative complications was low in both groups. Significant IMA spasm or insufficient IMA flow due to small-caliber vessels occurred in only 1.3% (8/638: 6 patients in group 1 and 2 patients in group 2) (n.s.). None of the patients with sequential IMA grafts in group 2 had early graft failure (within 30 days postoperatively). Twelve months postoperatively, 88% (83/94 survivors) of the patients who had received a sequential IMA graft were completely free of angina. Coronary revascularization with sequential IMA graft was found to be safe and effective. Specific IMA problems such as IMA spasm occurred rarely and not more frequently when the IMA was used as sequential graft.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it