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Mamedov A, Rumbinaitė E, Karčiauskas D, Jakuškaitė G, Veikutienė A, Jakuška P, Benetis R. Surgical coronary angioplasty of both coronary ostia after chest radiotherapy. Is it good alternative to conventional coronary bypass surgery? Perfusion 2023:2676591231221707. [PMID: 38066688 DOI: 10.1177/02676591231221707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Isolated coronary ostial stenosis of both ostia is a rare, potentially life-threatening condition, occurring in 0.1%-0.2% of patients undergoing coronary angiography. CASE REPORT We present a case of a 69-year-old woman with a past medical history of breast cancer, who had been treated with radiotherapy, which most likely caused significant stenosis of both coronary ostia and likely accelerated aortic stenosis. Surgical angioplasty with autopericardium patch reconstruction of the left main coronary artery and right coronary arteries due to proximal stenotic disease was performed instead of venous or arterial bypasses with concomitant aortic valve replacement. The postoperative course was uneventful. There were no cardiovascular events 5 years after operation, and the patient remained free of any symptoms. CONCLUSIONS Surgical coronary angioplasty offers an alternative to conventional coronary artery bypass grafting in isolated coronary ostial lesions and is advantageous in restoring more physiological myocardial perfusion, especially in those cases when conduits are suspected to be fibrotic, scarred or stenosed after radiation therapy or if there is the need to preserve conduits for future myocardial revascularisation in young patients.
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Affiliation(s)
- Arslan Mamedov
- Department of Cardiac, Thoracic and Vascular Sugery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Rumbinaitė
- Departament of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius Karčiauskas
- Department of Cardiac, Thoracic and Vascular Sugery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabrielė Jakuškaitė
- Departament of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Audronė Veikutienė
- Department of Cardiac, Thoracic and Vascular Sugery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuška
- Department of Cardiac, Thoracic and Vascular Sugery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Sugery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Cao Y, Asai H, Niwano H, Ikarashi J, Tachibana T. Surgical Angioplasty for a Single Coronary Artery With Myocardial Bridging. Ann Thorac Surg 2022; 114:e347-e350. [PMID: 35216995 DOI: 10.1016/j.athoracsur.2022.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 11/26/2022]
Abstract
Single coronary artery (SCA) with myocardial bridging (MB) is rare but associated with the risk of sudden cardiac death in children, yet there is no standardized treatment approach. We report a 6-year-old girl with chest pain having an SCA with complete MB of the left main coronary artery (LMCA) (modified Lipton type RII-S) branching from the right coronary artery at an acute angle. Coronary angioplasty using an in-situ aortic flap and an autologous pulmonary arterial patch combined with myocardial unroofing was successfully performed for the LMCA. The patient remains healthy for over 3 years without any exercise restriction.
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Affiliation(s)
- Yuchen Cao
- Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hidetsugu Asai
- Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Haruki Niwano
- Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jin Ikarashi
- Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tsuyoshi Tachibana
- Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
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Lu X, Han L, Guo X, Wang M, Baradarian S, Golts E, Kassab GS. Novel Biomaterial for Artery Patch in Swine Model With High-Fat Diet. Front Bioeng Biotechnol 2021; 9:679466. [PMID: 34222217 PMCID: PMC8247777 DOI: 10.3389/fbioe.2021.679466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objective We evaluated swine and bovine pulmonary visceral pleura (PVP) in artery patch-angioplasty in swine model of high-fat diet. Background Arterial patch-angioplasty is frequently used for repair or reconstruction of arteries. An autologous patch is often limited by the number and dimension of donor tissue and can result in donor complications. Furthermore, mechanical mismatch is a cause of poor performance of vascular reconstruction. Here, we introduce a readily available patch biomaterial with similar compliance as native arteries. Methods The PVP was peeled from swine and bovine lungs by hydro-dissection. The swine and bovine PVPs were crosslinked with glutaraldehyde and then sterilized. The swine PVP (sPVP) patches were implanted in the carotid and femoral arteries of six Yorkshire pigs that were fed a regular diet and euthanized at 2 and 4 months postoperative. The bovine PVP (bPVP) patches were implanted in the carotid artery of six Yucatan pigs that were fed a high-fat diet and euthanized at 4 months postoperative. Patency was evaluated by ultrasound and angiography. Neo-endothelium and media were evaluated by histologic examination. Results All arteries in patch-angioplasties remained patent with no adhesions, inflammation, or aneurysms. Biomarkers of endothelial cells (e.g., Factor VIII and eNOS) were detected in the neo-endothelial cells. We observed endothelial cell–cell junctions in the confluent neo-endothelium in the PVP patches. Neo-media composed of vascular smooth muscle developed similar as native arteries. In the hypercholesterolemic model, we observed the accumulation of cholesterol in both arterial tissues and in the neo-vascular tissues in the PVP patches. Protein expressions of lipid transport and metabolism (e.g., APOE-1, ABCA, and PACK9) were also observed in both arterial and neo-vascular tissues. Conclusion The PVP patch-angioplasty overcomes the pitfalls of compliance mismatch of synthetic patches and has a non-thrombogenic surface. The proliferation of vascular cells assembled to generate the neo-endothelium and media in the patch-angioplasties to support long-term patency. The neo-vascular tissue in PVP patch-angioplasty also developed similar cellular functions for lipid transport and metabolism compared with native arteries in hypercholesterolemia.
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Affiliation(s)
- Xiao Lu
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ling Han
- California Medical Innovations Institute, San Diego, CA, United States
| | - Xiaomei Guo
- California Medical Innovations Institute, San Diego, CA, United States
| | | | - Sam Baradarian
- Scripps Clinic Cardiovascular Surgery, San Diego, CA, United States
| | - Eugene Golts
- University of California San Diego (UCSD) Cardiovascular Surgery, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States.,3DT Holdings, San Diego, CA, United States
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Li D, Guo P, Chen L, Wu Y, Wang G, Xiao C. Outcomes of Surgical Patch Angioplasty of The Coronary Artery for Diffuse Coronary Artery Disease. Braz J Cardiovasc Surg 2020; 35:706-712. [PMID: 33118736 PMCID: PMC7598967 DOI: 10.21470/1678-9741-2019-0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Diffuse coronary artery disease (CAD) has a poor prognosis and many patients are ineligible for conventional coronary artery bypass grafting (CABG). This study evaluated the 12-month outcomes of coronary artery reconstruction and surgical patch angioplasty of the coronary artery for diffuse CAD. Methods A retrospective cohort study of patients who underwent CABG with surgical patch angioplasty of the coronary artery (reconstruction group) or standard CABG alone (standard group) at the Cardiovascular Surgery Department of the local Hospital between January 2014 and January 2016. Follow-up was censored at 12 months after surgery. Results Cardiopulmonary bypass and aortic cross-clamping durations were longer in the reconstruction group (n=32) than in the standard group (n=125) (P<0.05). There were no differences in graft blood flow and postoperative levels of cardiac markers between the two groups (P>0.05). In the reconstruction group, one patient died; a vein graft showed occlusion. In the standard group, two patients died; one left internal mammary artery graft and three vein grafts showed occlusion. There were no significant differences in mortality, major adverse cardiovascular and cerebrovascular events, and patency between the two groups (P>0.05). Conclusion Coronary artery reconstruction and surgical patch angioplasty of the coronary artery can be performed for diffuse CAD. Patient outcomes were not significantly different from those of patients who underwent standard CABG.
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Affiliation(s)
- Dong Li
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Pengfei Guo
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Lei Chen
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Yang Wu
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Gang Wang
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
| | - Cangsong Xiao
- Medical School of Chinese PLA Department of Cardiovascular Surgery Beijing China Department of Cardiovascular Surgery, Medical School of Chinese PLA, Beijing, China
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Coronary Ostial Patch Angioplasty With Femoral Artery in Takayasu Arteritis. Ann Thorac Surg 2020; 110:e427-e430. [PMID: 32376353 DOI: 10.1016/j.athoracsur.2020.03.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/22/2022]
Abstract
Takayasu arteritis (TA) occasionally involves the coronary ostium leading to myocardial ischemia. Although surgical coronary ostial angioplasty is desirable for ostial stenosis, the patch materials and long-term results are controversial. We used femoral artery (FA) as a patch material for coronary ostial angioplasty in 3 TA patients. Coronary ostial enlargement with a longitudinal incision followed by rectangular FA patch augmentation was performed to extend the narrowing coronary ostium. In all patients, coronary ostial stenosis was successfully repaired. Ostial angioplasty using an FA patch would be a reasonable surgical strategy to treat coronary ostial stenosis in TA.
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Oishi K, Arai H, Yoshida T. Coronary ostial plasty using femoral artery patch in Takayasu aortitis: A 15-year follow-up study. JTCVS Tech 2020; 3:176-178. [PMID: 34317861 PMCID: PMC8302872 DOI: 10.1016/j.xjtc.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/17/2020] [Accepted: 04/02/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
- Address for reprints: Hirokuni Arai, MD, PhD, Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519 Japan.
| | - Tetsuya Yoshida
- Department of Cardiovascular Surgery, Hokushin General Hospital, Nagano, Japan
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Lu X, Han L, Golts E, Baradarian S, Kassab GS. Homologous and heterologous assessment of a novel biomaterial for venous patch. J Vasc Surg Venous Lymphat Disord 2019; 8:458-469.e1. [PMID: 31837973 DOI: 10.1016/j.jvsv.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/11/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of veins. Autologous patches are often limited by the number and dimension of donor tissue and can result in donor complications. Bovine pericardium is the most common heterologous patch used by vascular surgeons. Researchers, however, are continually seeking to improve heterologous and synthetic patches for improved outcome. METHODS The PVP was peeled from swine and bovine lungs and cross-linked with glutaraldehyde. After sterilization and rinsing, the PVP patches were implanted in the jugular vein (10 × 35 mm) of pigs and dogs. Patency was evaluated by ultrasound, and animals were euthanized at 2 and 4 months. Neoendothelium and neomedia were evaluated by histologic analysis. RESULTS The jugular vein patched by PVP in pigs and dogs remained patent at 2 and 4 months with no adhesions, inflammation, or aneurysm in the patches. The biomarkers of endothelial cells-factor VIII, platelet/endothelial cell adhesion molecule 1, and endothelial nitric oxide synthase-were detected in the neoendothelial cells. The expression of vascular smooth muscle cell (VSMC) α-actin was robust in the neomedia at 2 and 4 months. Neomedia composed of VSMCs developed to nearly double the thickness of adjacent jugular vein. The circumferential orientation of VSMCs in neomedia further increased in the 4-month group. CONCLUSIONS The cross-linked swine and bovine PVP patch has a nonthrombogenic surface that maintains patency. The PVP patch may overcome the pitfall of compliance mismatch of synthetic patches. The proliferation of vascular cells assembled in the neoendothelium and neomedia in the patches may support long-term patency.
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Affiliation(s)
- Xiao Lu
- Division of Cardiovascular Bioengineering, California Medical Innovations Institute, San Diego, Calif
| | - Ling Han
- Division of Cardiovascular Bioengineering, California Medical Innovations Institute, San Diego, Calif
| | - Eugene Golts
- Division of Cardiovascular Surgery, University of California San Diego, San Diego, Calif
| | - Sam Baradarian
- Division of Cardiovascular Surgery, Scripps Clinic, San Diego, Calif
| | - Ghassan S Kassab
- Division of Cardiovascular Bioengineering, California Medical Innovations Institute, San Diego, Calif.
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Kreibich M, Bavaria JE, Branchetti E, Brown CR, Chen Z, Khurshan F, Siki M, Vallabhajosyula P, Szeto WY, Desai ND. Management of Patients With Coronary Artery Malperfusion Secondary to Type A Aortic Dissection. Ann Thorac Surg 2019; 107:1174-1180. [DOI: 10.1016/j.athoracsur.2018.09.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/13/2018] [Accepted: 09/24/2018] [Indexed: 10/27/2022]
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Iop L, Palmosi T, Dal Sasso E, Gerosa G. Bioengineered tissue solutions for repair, correction and reconstruction in cardiovascular surgery. J Thorac Dis 2018; 10:S2390-S2411. [PMID: 30123578 PMCID: PMC6081367 DOI: 10.21037/jtd.2018.04.27] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
The treatment of cardiac alterations is still nowadays a dramatic issue in the cardiosurgical practice. Synthetic materials applied in this surgery have failed in their long-term therapeutic efficacy due to low biocompatibility and compliance, especially when used in contractile sites. In order to overcome these treatment pitfalls, novel solutions have been developed based on biological tissues. Patches in pericardium, small intestinal submucosa, as well as engineered tissues of myocardium, heart valves and blood vessels have undergone a large preclinical investigation in regenerative medicine studies. Clinical translation has been started or reached by several of these new bioengineered treatment alternatives. This review will describe the preclinical and clinical experiences realized so far with the application of biological tissues in cardiovascular surgery. It will depict the progressive steps realized in the evolution of this research, as well as it will point out the challenges yet to face in order to generate the ideal biomaterial for cardiovascular repair, corrective and reconstructive surgery.
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Affiliation(s)
- Laura Iop
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Tiziana Palmosi
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Eleonora Dal Sasso
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gino Gerosa
- Cardiovascular Regenerative Medicine, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua and Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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Yildiz O, Altin FH, Kaya M, Ozyılmaz I, Guzeltas A, Erek E. Left coronary artery stenosis causing left ventricular dysfunction in two children with supravalvular aortic stenosis. World J Pediatr Congenit Heart Surg 2015; 6:311-6. [PMID: 25870356 DOI: 10.1177/2150135114563767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital supravalvar aortic stenosis (SVAS) is an arteriopathy associated with Williams-Beuren syndrome (WBS) and other isolated elastin gene deletions. Cardiovascular manifestations associated with WBS are characterized by obstructive arterial lesions such as SVAS and pulmonary artery stenosis in addition to bicuspid aortic valve and mitral valve prolapse. However, coronary artery ostial stenosis may be associated with SVAS, and it increases the risk of sudden death and may complicate surgical management. In this report, we present our experience with two patients having SVAS and left coronary artery ostial stenosis with associated left ventricular dysfunction.
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Affiliation(s)
- Okan Yildiz
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Firat H Altin
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kaya
- Department of Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Isa Ozyılmaz
- Department of Pediatric Cardiology, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ersin Erek
- Department of Pediatric Cardiovascular Surgery, Istanbul Mehmet AkifErsoy Thoracic & Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Lampropoulos K, Kavouras C, Charitos C. Left main reconstruction as an alternative method to CABG after primary PCI complication. Indian Heart J 2015; 67:259-61. [PMID: 26138184 DOI: 10.1016/j.ihj.2015.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/16/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022] Open
Abstract
Left main coronary artery disease is rare, accounting for 1% of all coronary artery disease and traditionally, is treated by coronary artery bypass grafting. We report our experience and five years follow up, after a coronary osteal surgical plasty in a young man who referred to our center with an anterior myocardial infarction.
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Affiliation(s)
- Konstantinos Lampropoulos
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece.
| | - Charalampos Kavouras
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece
| | - Christos Charitos
- Department of Cardiothoracic Surgery, Evaggelismos General Hospital of Athens, Greece
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Jeong JH, Lee WY, Kim EJ, Cho SW, Kim KI, Kim HS. Long-term results of surgical angioplasty for left main coronary artery stenosis: 18-year follow-up. J Cardiothorac Surg 2015; 10:6. [PMID: 25595512 PMCID: PMC4299293 DOI: 10.1186/s13019-015-0209-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to determine the long-term outcomes of surgical angioplasty for left main coronary artery (SA-LMCA) stenosis. Methods We retrospectively analyzed data from 24 consecutive patients (mean age, 55 years; male/female, 12/12) who underwent a surgical angioplasty for the left main coronary artery (LMCA) stenosis at our institution between 1995 and 2002. We used autologous pericardium in 7 patients and bovine pericardium in 17 patients as a patch. We evaluated the late mortality and major adverse cardiac events (MACE) rate. Results There was no operative mortality. Control coronary angiography exhibited wide open and funnel-shaped LMCA in all patients. One patient was lost to follow-up. During the mean follow-up of 167 months, there were 3 sudden cardiac deaths, 4 non-cardiac related deaths, and 9 MACE with one death at reoperation. The Kaplan-Meier method identified freedom from cardiac death in 95.7, 87.0, and 82.4% of the patients, and freedom from MACE in 91.3, 69.6, and 57.7% of the patients at 5, 10, and 15 years, respectively. Conclusions This study demonstrated that the long-term outcomes of SA-LMCA with a pericardial patch are acceptable compared to those of coronary artery bypass grafting, despite the controversy over the indications and the patch material used.
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Affiliation(s)
- Jae Han Jeong
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
| | - Won Yong Lee
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
| | - Eung-Joong Kim
- Department of Cardiothoracic Surgery, Hallym University Dongtan Sacred Heart Hospital, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
| | - Sung Woo Cho
- Department of Cardiothoracic Surgery, Hallym University Gangdong Sacred Heart Hospital, Gil-dong, Gangdong-gu, Seoul, 134-701, South Korea.
| | - Kun Il Kim
- Department of Cardiothoracic Surgery, Hallym University Dongtan Sacred Heart Hospital, Seoku-dong, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
| | - Hyoung Soo Kim
- Department of Cardiothoracic Surgery, Hallym University Sacred Heart Hospital, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do, 431-796, Koera.
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Sepehripour AH, Harling L, Ashrafian H, Athanasiou T. Pediatric Applications of Surgical Patch Angioplasty of the Main Coronary Trunks. World J Pediatr Congenit Heart Surg 2014; 5:283-90. [DOI: 10.1177/2150135113508795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Obstruction of the main coronary trunks, although rare among the general pediatric population, remains an important complication of the arterial switch operation (ASO). Surgical patch angioplasty (SPA) is a technique whereby myocardial revascularization is achieved through direct ostial enlargement, restoring antegrade coronary flow, avoiding competitive flow, and preserving conduit material. This study investigates the indications, techniques, and outcomes of SPA in the pediatric population. Methods: A systematic literature review identified 15 studies incorporating 92 patients. The primary outcome of interest was 30-day mortality. Secondary outcomes included 30-day major adverse cardiac and cerebrovascular events, mortality at last follow-up, reintervention rate, symptomatic status, angiographic patency, and myocardial perfusion status at last follow-up. Results: The SPA was most frequently performed to treat ostial occlusion as a complication of the ASO (73.9%). Of the procedures, 77.2% involved the left main stem, 8.7% the left anterior descending artery, and 14.1% the right coronary artery. Saphenous vein was the commonest patch type (60.9%) followed by autologous pericardium (23.9%). Of the procedures, 96.7% were considered successful with an uneventful postoperative recovery. Overall hospital mortality was 2.2%. At a mean of 39 months of follow-up, 84.8% of the patients were asymptomatic, 51.1% of the repairs were angiographically patent, 9.8% had myocardial perfusion defects, and 6.5% required repeat revascularization. Conclusion: Current evidence suggests that SPA shows encouraging outcomes in a pediatric population and, with increasing experience, may provide a definitive solution to coronary artery occlusion.
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Affiliation(s)
- Amir H. Sepehripour
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, United Kingdom
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Harling L, Ashrafian H, Athanasiou T. Reply to Almdahl. Eur J Cardiothorac Surg 2014; 46:758. [PMID: 24510910 DOI: 10.1093/ejcts/ezt650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Leanne Harling
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College London, London, UK
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15
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Almdahl SM. A piece of the aorta as patch material for angioplasty of the left main coronary artery. Eur J Cardiothorac Surg 2014; 46:757. [PMID: 24510907 DOI: 10.1093/ejcts/ezt652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sven M Almdahl
- Department of Cardiac Surgery, Feiring Heart Clinic, Feiring, Norway Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway
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Terada T, Sakurai H, Nonaka T, Sakurai T, Sugiura J, Taneichi T, Ohtsuka R. A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child. Gen Thorac Cardiovasc Surg 2013; 63:660-3. [PMID: 24113996 DOI: 10.1007/s11748-013-0330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022]
Abstract
Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium. We were able to clearly expose the left main trunk behind the pulmonary artery because the obstruction was divided for the patch material. The postoperative course was uneventful, and coronary angiography at 4 months after surgery showed excellent patency of the left main trunk. The auto-pulmonary arterial wall was easy to handle during angioplasty, and its favorable durability has been established both in the Ross procedures and in an arterial switch procedure. Therefore, we conclude that patch angioplasty using a piece of the pulmonary arterial wall represents a good alternative to conventional coronary artery bypass grafting.
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Affiliation(s)
- Takafumi Terada
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan.
| | - Hajime Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Toshimichi Nonaka
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Takahisa Sakurai
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Junya Sugiura
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Tetsuyoshi Taneichi
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
| | - Ryohei Ohtsuka
- Department of Cardiovascular Surgery, Chukyo Hospital, Sanjo 1-1-10 Minami-ward, Nagoya, Aichi, 457-8510, Japan
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