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Gikandi A, Stock E, DeMatt E, Hirji S, Awtry J, Quin JA, Tolis G, Biswas K, Zenati MA. Performance of left internal thoracic artery-left anterior descending artery anastomosis by residents versus attendings and coronary artery bypass grafting outcomes. Eur J Cardiothorac Surg 2024; 65:ezae155. [PMID: 38598201 DOI: 10.1093/ejcts/ezae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Performance of a technically sound left internal thoracic artery to left anterior descending artery (LITA-LAD) anastomosis during coronary artery bypass grafting (CABG) is critically important. We used prospectively collected data from the multicentre, randomized REGROUP (Randomized Endograft Vein Perspective) trial to investigate CABG outcomes based on whether a resident or an attending surgeon performed the LITA-LAD anastomosis. METHODS This was a post hoc subanalysis of the REGROUP trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest from 2014 through 2017. The primary end point was major cardiac adverse events, defined as the composite of all-cause deaths, nonfatal myocardial infarctions or repeat revascularizations. RESULTS Among 1,084 patients, 344 (31.8%) LITA-LAD anastomoses were performed by residents and 740 (68.2%), by attending surgeons. Residents (compared to attendings) operated on fewer patients with high tercile SYNTAX scores (22.1% vs 37.4%, P < 0.001), performed fewer multiarterial CABGs (5.2% vs 14.6%, P < 0.001) and performed more anastomoses to distal targets with diameters > 2.0 mm (19.0% vs 10.9%, P < 0.001) and non-calcified landing zones (25.1% vs 21.6%, P < 0.001). During a median observation time of 4.7 years (interquartile range 3.84-5.45), major cardiac adverse events occurred in 77 patients (22.4%) in the group treated by residents and 169 patients (22.8%) in the group treated by attendings (unadjusted HR 1.00; 95% confidence interval, 0.76-1.33; P = 0.99). Outcomes persisted on adjusted analyses. CONCLUSIONS Based on this REGROUP trial subanalysis, under careful supervision and with appropriate patient selection, LITA-LAD anastomoses performed by the residents yielded clinical outcomes similar to those of the attendings.
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Affiliation(s)
- Ajami Gikandi
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eileen Stock
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Ellen DeMatt
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jake Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacquelyn A Quin
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
| | - George Tolis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kousick Biswas
- VA Cooperative Studies Program Coordinating Center, Office of Research and Development, U.S. Department of Veterans Affairs, Perry Point, MD, USA
| | - Marco A Zenati
- Division of Cardiac Surgery, Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Zhang JZ, Zhu GY, Zhang Y, Bai LJ, Wang Z. Myocardial Bridge Bypass Graft: A Novel Surgical Procedure for Extensive Myocardial Bridges. Ann Thorac Surg 2021; 112:e115-e117. [PMID: 33482166 DOI: 10.1016/j.athoracsur.2020.11.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
In patients with myocardial bridges (MBs) and insufficient medical management, the optimal surgical strategy remains undetermined. Based on computer simulations we developed a novel procedure, MB bypass grafting, that showed better hemodynamics compared with coronary artery bypass grafting in a simulation study. In this novel procedure the left internal mammary artery was used to connect the proximal and distal ends of the MB. For the first time we used MB bypass grafting to treat a patient with extensive MB. The patient recovered well after surgery, and the left internal mammary artery graft remained patent 3 months postoperatively.
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Affiliation(s)
- Jin-Zhou Zhang
- Department of Cardiovascular Surgery, Xi'an International Medical Center, Northwest University, Xi'an, China.
| | - Guang-Yu Zhu
- School of Energy and Power Engineering, Xi`an Jiaotong University, Xi'an, China
| | - Yu Zhang
- Department of Cardiovascular Surgery, Xi'an International Medical Center, Northwest University, Xi'an, China
| | - Li-Jun Bai
- Department of Cardiovascular Surgery, Xi'an International Medical Center, Northwest University, Xi'an, China
| | - Zhen Wang
- Department of Cardiovascular Surgery, Xi'an International Medical Center, Northwest University, Xi'an, China
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Akhtar Z, Shah N, Bogle R. Ambidextrous Angiography: Mother-and-Child Telescopic Catheter Technique to Evaluate LIMA and RIMA Grafts From the Radial Approach. J Invasive Cardiol 2019; 31:E157. [PMID: 31158814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Left heart catheterization graft study is commonly performed via the femoral approach to allow selective angiography of internal mammary grafts, which originate from either subclavian artery. A straightforward mother-and-child catheter-extension technique allows this procedure to be performed successfully via radial approach, which improves patient comfort and offers less likelihood of vascular complications.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St. George's University Hospital NHS Trust, Cranmer Terrace. London SW17 0RE, United Kingdom.
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Taggart DP, Altman DG, Flather M, Gerry S, Gray A, Lees B, Benedetto U. Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes: Insights From the Arterial Revascularization Trial. Circulation 2017; 136:454-463. [PMID: 28566338 DOI: 10.1161/circulationaha.117.027659] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whether the use of the radial artery (RA) can improve clinical outcomes in coronary artery bypass graft surgery remains unclear. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral internal thoracic artery (BITA) over single left internal thoracic artery (SITA). In the ART, a large proportion of patients (≈20%) also received an RA graft instead of a saphenous vein graft (SVG). We aimed to investigate the associations between using the RA instead of an SVG to supplement SITA or BITA grafts and outcomes by performing a post hoc analysis of the ART. METHODS Patients enrolled in the ART (n=3102) were classified on the basis of conduits actually received (as treated). The analysis included 2737 patients who received an RA graft (RA group; n=632) or SVG only (SVG group; n=2105) in addition to SITA or BITA grafts. The primary end point was the composite of myocardial infarction, cardiovascular death, and repeat revascularization at 5 years. Propensity score matching and stratified Cox regression were used to compare the 2 strategies. RESULTS Myocardial infarction, cardiovascular death, and repeat revascularization cumulative incidence was 2.3% (95% confidence interval [CI], 1.1-3.4), 3.5% (95% CI, 2.1-5.0), and 4.4% (95% CI, 2.8-6.0) in the RA group and 3.4% (95% CI, 2.0-4.8), 4.0% (95% CI, 2.5-5.6), and 7.6% (95% CI, 5.5-9.7) in the SVG group, respectively. The composite end point was significantly lower in the RA group (8.8%; 95% CI, 6.5-11.0) compared with the SVG group (13.6%; 95% CI, 10.8-16.3; P=0.005). This association was present when an RA graft was used to supplement both SITA and BITA grafts (interaction P=0.62). CONCLUSIONS This post hoc ART analysis showed that an additional RA was associated with lower risk for midterm major adverse cardiac events when used to supplement SITA or BITA grafts. CLINICAL TRIAL REGISTRATION URL: https://www.situ.ox.ac.uk/surgical-trials/art. Unique identifier: ISRCTN46552265.
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Affiliation(s)
- David P Taggart
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Douglas G Altman
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Marcus Flather
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Stephen Gerry
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Alastair Gray
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Belinda Lees
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.)
| | - Umberto Benedetto
- From Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, United Kingdom (D.P.T., B.L.); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (D.G.A., S.G.), and Department of Public Health, Health Economics Research Centre (A.G.), University of Oxford, United Kingdom; Norwich Medical School, University of East Anglia, and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom (M.F.); and Bristol Heart Institute, School of Clinical Sciences, University of Bristol, United Kingdom (U.B.).
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Kane G, Rajani R, Parekh M. Retrograde revascularization of ostial left main CTO using internal mammary artery byepass graft: A case report. Int J Cardiol 2016; 222:319-320. [PMID: 27500757 DOI: 10.1016/j.ijcard.2016.07.290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/30/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Ghanshyam Kane
- Department of Cardiology, P. D. Hinduja Hospital, Mahim (W), Mumbai 400019, India
| | - Rajesh Rajani
- Department of Cardiology, P. D. Hinduja Hospital, Mahim (W), Mumbai 400019, India
| | - Maulik Parekh
- Department of Cardiology, P. D. Hinduja Hospital, Mahim (W), Mumbai 400019, India.
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Chaudhri MS, Shah MUA, Asghar MI, Siddiqi R, Janjua AM, Iqbal A. Skeletonization of Left Internal Mammary Artery in Coronary Artery Bypass Grafting. J Coll Physicians Surg Pak 2016; 26:736-739. [PMID: 27671175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery (LIMA) in patients undergoing coronary artery bypass grafting (CABG) surgery. STUDY DESIGN Randomized control trial. PLACE AND DURATION OF STUDY Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from February to August, 2013. METHODOLOGY Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMAharvesting. Free flow was checked just before anastamosis of each LIMAto the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. Aspecialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18. RESULTS The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group (p=0.04). CONCLUSION Skeletonized IMAhad superior flow to pedicled IMAin addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization.
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Affiliation(s)
- Muhammad Sohail Chaudhri
- Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
| | - Muhammad Usman Ali Shah
- Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
| | - Muhammad Imran Asghar
- Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
| | - Rashad Siddiqi
- Department of Cardio-Thoracic Anesthesia,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
| | - Asif Mahmood Janjua
- Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
| | - Afsheen Iqbal
- Department of Cardiac Surgery,Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi
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Abstract
Coronary ostial stenosis is one of the cardiac manifestations of tertiary syphilis and should be perceived as a disorder of the aorta. A 45-year-old man with no coronary risk factors except smoking developed severe isolated ostial stenosis in the left main coronary artery. He underwent emergency bypass surgery using the bilateral internal thoracic arteries as a composite Y-graft, and recovered uneventfully.
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Affiliation(s)
- Keita Tanaka
- Division of Cardiovascular Surgery, Teikyo University School of Medicine Ichihara Hospital, Ichihara City, Japan.
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8
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Abstract
Minimally invasive operations designed to graft the left anterior descending coronary artery with the left internal mammary artery are either traumatic to the chest wall or technically difficult and expensive. This report describes a novel procedure that is less traumatic and simpler.
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Affiliation(s)
- Thomas A Vassiliades
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
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9
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Navia DO, Vrancic M, Piccinini F, Camporrotondo M, Dorsa A, Espinoza J, Benzadon M, Camou J. Myocardial Revascularization Exclusively With Bilateral Internal Thoracic Arteries in T-Graft Configuration: Effects on Late Survival. Ann Thorac Surg 2016; 101:1775-81. [PMID: 26822347 DOI: 10.1016/j.athoracsur.2015.10.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/10/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease. METHODS Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659). In patients who underwent BITA grafting, the left internal thoracic artery (LITA) was grafted mainly to the left anterior descending artery, whereas the right internal thoracic artery (RITA) was used more commonly to graft the circumflex (Cx) artery and the right coronary system as T-grafts. A total of 485 pairs of patients were matched using propensity scores. Cox proportional hazard models were generated to examine the association of arterial BITA grafting with mortality. RESULTS Patients in the BITA group were more likely to be younger (BITA, 63.7 ± 9.1 versus SITA, 65.0 ± 9.9; p < 0.0001). At 30 days, patients who underwent BITA grafting experienced reduced unadjusted mortality (BITA, 1.2% versus SITA, 4.4%; p < 0.0001). At 10 years, patients who underwent BITA grafting experienced superior unadjusted survival (BITA, 82.6% ± 1.8% versus SITA, 76.1% ± 1.3%; p = 0.001). Cox regression analysis in the entire study cohort showed that BITA grafting was associated with improved survival (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.87; p < 0.001). In the propensity-score-adjusted analysis, patients who underwent BITA grafting had similar in-hospital mortality (BITA, 1.6% versus SITA, 2.9%; p = 0.196). Patients who underwent BITA grafting still showed improved survival at 10 years (BITA, 81.0% ± 4.1% versus SITA, 71.8% ± 2.5%; p = 0.039). CONCLUSIONS This study suggests that coronary artery operations exclusively with BITA grafting in a T-configuration may be associated with better long-term survival than grafting with SITA plus other types of conduits.
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Affiliation(s)
- Daniel O Navia
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
| | - Mariano Vrancic
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Piccinini
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Camporrotondo
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Dorsa
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan Espinoza
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Benzadon
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan Camou
- Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Borović MML, Lalić IM, Borović SD, Zaletel IV, Mutavdzin SS, Bajčetić MI, Kostić JV, Trifunović ZZ. Structural features of arterial grafts important for surgical myocardial revascularization: Part I--Histology of the internal thoracic artery. VOJNOSANIT PREGL 2015; 72:914-921. [PMID: 26665558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Cohen RG. The patent internal thoracic artery graft: Increased degree of difficulty for left-sided pulmonary resections. J Thorac Cardiovasc Surg 2015; 150:536-7. [PMID: 26254761 DOI: 10.1016/j.jtcvs.2015.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Robbin G Cohen
- Department of Surgery, Keck/USC School of Medicine, Healthcare Consultation Center II, Los Angeles, Calif.
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Deo SV, Altarabsheh SE, Shah IK, Cho YH, McGraw M, Sarayyepoglu B, Medalion B, Markowitz AH, Park SJ. Are two really always better than one? Results, concerns and controversies in the use of bilateral internal thoracic arteries for coronary artery bypass grafting in the elderly: a systematic review and meta-analysis. Int J Surg 2015; 16:163-70. [PMID: 25598216 DOI: 10.1016/j.ijsu.2015.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/05/2015] [Accepted: 01/11/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Bilateral internal thoracic artery grafting appears to be the preferred method to achieve durable long-term coronary artery revascularization. However, data reporting the benefit of this technique in the elderly is very conflicting. METHOD We performed a systematic review of available literature (till November 2014) using multiple databases to identify studies comparing clinical events in patients undergoing coronary artery bypass grafting using either a single or double internal thoracic artery in the elderly. While early mortality was the primary end-point of inclusion, other adverse events compared were sternal wound infection (deep and superficial), stroke and peri-operative myocardial infarction. Individual and pooled odd's ratios were calculated using the Mantel-Haenzel method (random effect model); sensitivity analysis was performed. Results are presented using 95% confidence intervals. RESULT Nine retrospective studies (4479 BITA, 7733 LITA patients) fulfilled search criteria. Deep sternal wound infection was significantly higher after BITA harvest [OR 1.86 (1.3-2.5); I(2) = 0%; p < 0.01]. Early mortality (BITA 3.6% vs SITA 3.1%; p = 0.86), stroke [OR 0.7(0.4-1.1); p = 0.1], and peri-operative myocardial infarction (BITA 4.3% vs SITA 2.3%; p = 0.1) were comparable in both cohorts. Long-term survival favored the BITA cohort in two propensity matched studies. CONCLUSION The incidence of deep sternal wound infection may be significantly higher after the harvest of both internal thoracic arteries in the elderly. While other post-operative adverse events are comparable, data regarding the long-term survival advantage in this cohort is conflicting. Hence, the use of both internal thoracic arteries in this age group needs to be invidualized.
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Affiliation(s)
- Salil V Deo
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA.
| | - Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Ishan K Shah
- Department of Surgery, University of Minnesota, Minneapolis-St.Paul, MN, USA
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan School of Medicine, Samsung Hospital, Seoul, South Korea
| | - Michael McGraw
- Health Sciences Library, Case Western Reserve University, Cleveland, OH, USA
| | - Basar Sarayyepoglu
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
| | - Benjamin Medalion
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
| | - Alan H Markowitz
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
| | - Soon J Park
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Case Medical Center, University Hospitals, Cleveland, OH, USA
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Altun G, Pulathan Z, Kutanis D, Hemsinli D, Erturk E, Civelek A. Conservative management of chylothorax after coronary artery bypass grafting. Tex Heart Inst J 2015; 42:148-51. [PMID: 25873827 DOI: 10.14503/thij-13-3532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chylothorax is a rare sequela to cardiac surgery, associated with high rates of morbidity and mortality. There are various medical and surgical options for its management. We describe 2 cases of chylothorax that developed after coronary artery bypass grafting and were managed successfully with medical therapy alone. Conservative treatment such as we describe aims to reduce chyle flow, to drain the pleural cavity in an effective manner, and to prevent chronic sequelae. Optimal conservative treatment, consisting of nothing by mouth and the administration of a pleurodetic agent, should be started immediately upon diagnosis. In most cases, it reduces the need for reoperation and long-term hospitalization. Prospective randomized controlled trials are nonetheless needed to confirm these assumptions.
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14
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Ogawa S, Okawa Y, Sawada K, Goto Y, Yamamoto M, Koyama Y, Baba H, Suzuki T. Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity-matched analysis. Eur J Cardiothorac Surg 2015; 49:420-6. [PMID: 25825261 DOI: 10.1093/ejcts/ezv106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/24/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA. METHODS The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed. The study population consisted of 95 patients who received CIT and 126 patients who received IST. Furthermore, a one-to-one matched analysis based on estimated propensity scores for patients who received CIT or IST yielded two groups comprising 58 patients each. The proportion of patients with DSWI, overall survival rates and major adverse cardiac events were compared between the two groups in the overall and the propensity-matching cohort. RESULTS The prevalence of DSWI requiring debridement and closure was significantly reduced in the CIT group compared with that in the IST group [1/95 (1.1%) vs 9/126 (7.1%), P = 0.031]; these results were not attenuated even after propensity-matching analysis [0/58 (0%) vs 6/58 (10.3%), P = 0.031]. The mean preoperative glucose levels were similar between the two groups (157.5 ± 54.6 vs 176.1 ± ±70 mg/dl, P = 0.063), whereas the mean glucose values were significantly lower on the first and second operative days in the CIT group than in the IST group (132.9 ± 44.1 vs 197.8 ± 78.6 mg/dl, P < 0.0001; 153.5 ± 58.8 vs 199.6 ± 89.1 mg/dl, P < 0.0001, respectively). The glucose variability levels within 24 h postoperatively were significantly higher in the IST group (46.1 ± 19.4 vs 66.4 ± 26.8 mg/dl, P < 0.0001). The 30-day and 1-year survival rates were similar between the two groups (100 vs 99.2%, P = 0.384; 96.6 vs 94.4%, P = 0.454). No results were changed in the propensity-matching models. CONCLUSIONS The CIT approach reduced the variability in glucose concentration and resulted in fewer instances of DSWI after CABG with BIMA grafts.
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Affiliation(s)
- Shinji Ogawa
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yasuhide Okawa
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Koshi Sawada
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | | | - Yutaka Koyama
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Hiroshi Baba
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Takahiko Suzuki
- Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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Davierwala PM, Mohr FW. Bilateral internal mammary artery grafting: rationale and evidence. Int J Surg 2015; 16:133-9. [PMID: 25612853 DOI: 10.1016/j.ijsu.2015.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 11/19/2022]
Abstract
Coronary artery bypass graft (CABG) surgery remains the preferred mode of revascularization in patients with complex multi-vessel coronary artery disease. The left internal mammary artery (IMA) and saphenous vein are the most commonly utilized conduits in CABG surgery and are still considered to be the gold standard by most surgeons. However, there is emerging evidence that use of bilateral IMAs is associated with significantly better long-term outcomes and the benefit increases with time from surgery. In spite of this incremental beneficiary effect, most surgeons are reluctant to use both IMAs, because it is technically more demanding, time-consuming and is associated with marginally higher sternal wound infection rates. This review highlights the histological features, physiological characteristics and genomics of IMAs that provide the basis for the use of these vessels during CABG surgery. Additionally, the superiority of the bilateral IMAs with regard to patency and long-term outcomes is also discussed in detail. Furthermore, the safety of using bilateral IMAs with regard to early postoperative outcomes with special reference to deep sternal wound infections has been addressed. The present review provides enough evidence to convince more surgeons about the advantages of bilateral IMA grafting.
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Affiliation(s)
- Piroze M Davierwala
- Department of Cardiac Surgery, Heart Center, University Leipzig, Leipzig, Germany; Herzzentrum Leipzig, Universitätsklinik, Helios Kliniken, Struempellstraße 39, 04289 Leipzig, Germany.
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Center, University Leipzig, Leipzig, Germany; Herzzentrum Leipzig, Universitätsklinik, Helios Kliniken, Struempellstraße 39, 04289 Leipzig, Germany.
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16
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Weich HSVH, van Wyk J, Pecoraro AJ, Mabin T. Hybrid internal mammary to left anterior descending bypass and transaortic transcatheter aortic valve implantation: a new treatment option for patients with complex disease. J Heart Valve Dis 2014; 23:659-661. [PMID: 25799718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The case is described of a hybrid trans-aortic transcatheter aortic valve implantation and off-pump left internal mammary artery to left anterior descending artery bypass surgery in a man with a tight left main lesion and severe symptomatic aortic stenosis.
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Milani R, de Moraes D, Sanches A, Jardim R, Lumikoski T, Miotto G, Santana VH, Brofman PR. Analysis of transit time flow of the right internal thoracic artery anastomosed to the left anterior descending artery compared to the left internal thoracic artery. Braz J Cardiovasc Surg 2014; 29:148-55. [PMID: 25140463 PMCID: PMC4389469 DOI: 10.5935/1678-9741.20140061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION We evaluated with transit time flow the performance of the right and left thoracic arteries when used as a graft for the left anterior descending artery. METHODS Fifty patients undergoing surgery for myocardial revascularization without cardiopulmonary bypass were divided into two groups. In group A patients received graft of right internal mammary artery to the anterior interventricular branch. In group B patients received graft of left internal mammary artery to the same branch. At the end of the operation the flow was assessed by measuring transit time. RESULTS In group A, mean age was 60.6 ± 9.49 years. The average height and weight of the group was 80.4 ± 10.32 kg and 169.2 ± 6.86 cm. The average number of grafts per patient in this group was 3.28 ± 1.49. The mean flow and distal resistance obtained in right internal thoracic artery was 42.1 ± 23.4 ml/min and 2.8 ± 0.9 respectively. In group B, the mean age was 59.8 ± 9.7 years. The average height and weight of this group was 77.7 ± 14.22 kg and 166.0 ± 8.2 cm. The average number of grafts per patient in this group was 3.08 ± 0.82. The mean flow and distal resistance observed in this group was 34.2 ± 19.1 ml/min and 2.0 ± 0.7. There were no deaths in this series. CONCLUSION Right internal mammary artery presented a similar behavior to left internal mammary artery when anastomosed to the anterior interventricular branch of the left coronary artery. There was no statistical difference between the measured flow obtained between both arteries.
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Affiliation(s)
- Rodrigo Milani
- Correspondence address: Rodrigo Milani, Rua Cezar Correia de Souza Jr.
54 - Curitiba. PR. Brazil - Zip code: 82015-220. E-mail:
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18
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Raja SG, Benedetto U, Jothidasan A, Jujjavarapu RK, Ukwu UF, De Robertis F, Bahrami T, Gaer JA, Amrani M. Right internal mammary artery versus radial artery as second arterial conduit in coronary artery bypass grafting: a case-control study of 1526 patients. Int J Surg 2014; 16:183-9. [PMID: 25153938 DOI: 10.1016/j.ijsu.2014.08.342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/04/2014] [Accepted: 08/09/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Additional arterial grafts such as the right internal mammary artery (RIMA) or the radial artery (RA) have been proposed to improve long term outcomes in coronary artery bypass grafting (CABG). RA is largely preferred over RIMA as it is less technically demanding and there is a perception that bilateral IMA usage increases the risk of sternal wound complications. However, there is a paucity of direct comparison of the two conduits to guide surgeons to choose the best second arterial conduit for CABG. METHODS A propensity score adjusted analysis of patients undergoing multiple arterial grafting with RIMA (n = 747) and RA (n = 779) during the study period (2001-2013) was conducted to investigate the impact of the two strategies on early and late outcomes. RESULTS RIMA did not increase the incidence of postoperative complications including deep sternal wound infection (P = 0.8). Compared to the RIMA, the RA was associated with an increased risk for late mortality (Hazard Ratio [HR] 1.9; 95% confidence interval (CI) 1.2-3.1; P = 0.008) and repeat revascularization (HR 1.5; 95% CI 1.0-2.2; P = 0.044). A trend towards an extra risk for late mortality from RA over RIMA was observed among diabetic (HR 3.3; 95% CI 1.1-9.7) and obese patients (HR 2.1; 95% CI 0.8-5.46). CONCLUSIONS RIMA as a second conduit did not increase the operative risk including sternal wound complications and improved long term outcomes including overall survival when compared to RA. This advantage was stronger among diabetic and obese patients. These findings strongly support RIMA as the first choice second arterial conduit in CABG. Further randomized studies with angiographic control and long-term follow-up are needed to address this issue.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
| | - Umberto Benedetto
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Anand Jothidasan
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | | | | | - Fabio De Robertis
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Toufan Bahrami
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Jullien A Gaer
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
| | - Mohamed Amrani
- Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom
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Gerasimov AM, Merkulov EV, Samko AN, Koshel' II. [Embolization of mammary artery branches after mammary artery bypass surgery]. Vestn Rentgenol Radiol 2014:42-45. [PMID: 25775887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Even after performed mammary artery bypass surgery, some patients continued to have clinical manifestations of angina pectoris. This may be associated with the development of coronary stealing syndrome due to the fact that the native intrathoracic artery has large lateral branches. Current methods for embolization of arteries of different diameters make it possible to accomplish this task reasonably safely and in full measure. This paper describes a clinical case of reembolization of the lateral branch of a mammary artery shunt with an intravascular coil.
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20
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Bawany FI, Khan MS, Khan A, Kazi AN, Naeem M. Using skeletonised grafts for coronary artery bypass grafting. J PAK MED ASSOC 2014; 64:606-610. [PMID: 25272561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Coronary artery bypass graft surgery relieves angina symptoms and reduces mortality among ischaemic heart disease patients. It remains the gold standard for the treatment of multi-vessel and left main coronary artery disease. It is a well-known fact that internal mammary artery conduits have excellent and long-lasting patency when used for coronary artery bypass grafting. Its supremacy is largely because it prevents atherosclerosis. The old-style internal mammary artery bypass grafting, classically known as pedicle grafting, includes a circular rim of tissue around the graft. Bilateral pedicled internal mammary arteries, especially among diabetic patients, have been reported to cause complications in the sternum like sternal osteomyelitis. In many studies it has been reported that dissection of pedicled internal mammary artery can lead to sternal devascularisation which can lead to higher incidence of infections. Considering the higher incidence of deep sternal infections in patients with double pedicled arterial grafts, dissection of internal mammary artery in skeletonised manner was proposed. In this review, we outline the advantages of skeletonised grafting with respect to incidence of sternal infection, patency rates, blood flow, post-coronary artery bypass graft pain and the length of the graft.
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Sobral MLP, dos Santos Júnior SF, de Sá JC, Terrazas ADS, Trompieri DFDM, de Sousa TAN, dos Santos GG, Stolf NAG. Improvement in cardioplegic perfusion technique in single aortic clamping - initial results. Braz J Cardiovasc Surg 2014; 29:229-35. [PMID: 25140473 PMCID: PMC4389463 DOI: 10.5935/1678-9741.20140026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 11/17/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The most common method used for myocardial protection is administering cardioplegic solution in the coronary circulation. Nevertheless, protection may be achieved by intermittent perfusion of the coronary system with patient's own blood. The intermittent perfusion may be performed by multiple sequences of clamping and opening of the aortic clamp or due single clamping and accessory cannulation of the aortic root as in the improved technique proposed in this study, reperfusion without the need for multiple clamping of the aorta. OBJECTIVE To evaluate the clinical outcome and the occurrence of neurological events in in-hospital patients submitted to myocardial revascularization surgery with the "improved technique" of intermittent perfusion of the aortic root with single clamping. METHODS This is a prospective, cross-sectional, observational study that describes a myocardial management technique that consists of intermittent perfusion of the aortic root with single clamping in which 50 patients (mean age 58.5 ± 7.19 years old) have been submitted to the myocardial revasculrization surgery under the proposed technique. Clinical and laboratory variables, pre- and post-surgery, have been assessed. RESULTS The mean peak level of post-surgery CKMB was 51.64 ± 27.10 U/L in the second post-surgery and of troponin I was 3.35 ± 4.39 ng/ml in the fourth post-surgery, within normal limits. No deaths have occurred and one patient presented mild neurological disorder. Hemodynamic monitoring has not indicated any changes. CONCLUSION The myocardial revascularization surgery by perfusion with the improved technique with intermittent aortic root with single clamping proved to be safe, enabling satisfactory clinical results.
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Affiliation(s)
| | | | | | | | | | | | - Gilmar Geraldo dos Santos
- Instituto do Coração da Faculdade de Medicina da Universidade de São
Paulo INCOR/FMUSP, São Paulo, SP, Brazil
| | - Noedir Antonio Groppo Stolf
- Instituto do Coração da Faculdade de Medicina da Universidade de São
Paulo (FMUSP), São Paulo, SP, Brazil. Real e Benemérita Associação Portuguesa de São
Paulo, São Paulo, SP, Brazil
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22
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Abstract
The success of coronary artery bypass grafting, the gold standard for the treatment of multivessel coronary artery disease, is limited by poor long-term vein-graft patency. By contrast, the left internal mammary artery has been demonstrated to have a superior graft patency rate and has provided excellent clinical results. This suggests that the use of arterial conduits for coronary artery bypass grafting may be beneficial for long-term results. Recently, there has been an upsurge in the use of arterial grafts for myocardial revascularization based on the clinical advantage of the use of the left internal mammary artery as a bypass conduit. Many retrospective studies have supported the safety and the effectiveness of arterial grafting, and it has become apparent that the free arterial graft can be used as a branched or a lengthened conduit to the in situ arterial graft by adopting one or more of the several composite grafting techniques. Arterial composite grafts with or without sequential grafting techniques appear an attractive strategy as increased number of distal coronary anastomoses can be performed, with a limited number of grafts, avoiding proximal aortic anastomoses. However, concerns regarding the total dependence of the coronary bypass flow on the flow of one in situ arterial graft and technical error, resulting in compromised flow in one or both limbs of the composite graft have prevented composite arterial grafting from being universally adopted. It is expected that in the near future a prospective, multi-institutional, randomized controlled trial, to compare the short- and long-term outcomes of exclusive arterial grafting using composite and conventional aortocoronary revascularization strategies, will be undertaken to validate the safety and efficacy of composite arterial grafting.
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Affiliation(s)
- Shahzad G Raja
- Glasgow Royal Infirmary, Department of Cardiothoracic Surgery Ward 65, Queen Elizabeth Building, 16 Alexandra Parade, G31 2ER, Glasgow, UK.
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23
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Abstract
The superiority of the left internal mammary artery over the saphenous vein graft led many surgeons to adopt bilateral internal mammary artery (BIMA) as a good surgical option for further improving late outcome of patients undergoing myocardial revascularization. However, routine use of BIMA was limited by some potential drawbacks: the increase of deep sternal wound problems, especially in diabetic patients; the shortness of right internal mammary artery (RIMA), which limited its utilization as an in situ graft; the low patency rate if grafted to the right coronary artery; and the longer operative time. The skeletonization of the internal mammary artery along with a better glucose control in diabetic patients significantly reduced the incidence of deep sternal problems. Another problem to solve was finding the optimal target of the RIMA. The general consensus is that RIMA appears to be more efficient if grafted to the lateral wall. The Y or T configuration of double mammary arteries could be more helpful to reach the lateral target vessels. Finally, recent reports clearly demonstrate the superiority of BIMA over single internal mammary artery in terms of survival or quality of life. The latter finding has also been reported in diabetic patients.
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Cherniavskiĭ AM, Kavteladze ZA, Cherniavskiĭ MA, Edemskiĭ AG. Hybrid technology in treatment of severe combined pathology. Angiol Sosud Khir 2014; 20:158-166. [PMID: 24961338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The present report describes a clinical case concerning a two-stage hybrid operative intervention in a patient presenting with an aortic arch aneurysm associated with coronary artery disease. The first stage consisted in performing mammary coronary artery bypass grafting of the anterior descending artery, coronary artery bypass grafting of the right coronary artery, endoventricular plasty of the left ventricle according to the Dor technique, switching over of the brachiocephalic arteries to the ascending portion of the aorta with the vascular multiple-branch prosthesis Intergard. The second stage consisted in endoprosthetics of the aortic arch with a stent graft. The patient concerned belongs to a high-risk group for the development of postoperative complications. Endovascular techniques in the pathology involved may be an alternative to the conventional surgical treatment, since there is no necessity to use extracorporeal haemocirculation or deep hypothermal circulatory arrest. It is necessary to analyse the remote results, to work out the indications for the interventions concerned, especially in elderly and aged patients presenting with a variety of accompanying pathology.
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Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl 2013; 95:481-5. [PMID: 24112493 PMCID: PMC5827271 DOI: 10.1308/003588413x13629960047119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. METHODS Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. RESULTS Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). CONCLUSIONS MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.
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Dorman MJ, Kurlansky PA, Traad EA, Galbut DL, Zucker M, Ebra G. Response to letter regarding article, “Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score–matched cohorts”. Circulation 2013; 128:e73. [PMID: 24058955 DOI: 10.1161/circulationaha.113.002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Habib RH, Schwann TA. Letter by Habib and Schwann regarding article, "Bilateral internal mammary artery grafting enhances survival in diabetic patients: a 30-year follow-up of propensity score-matched cohorts". Circulation 2013; 128:e72. [PMID: 23897854 DOI: 10.1161/circulationaha.113.001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parissis H, Soo AW, Al-Alao B. Is there any further advantage of using more than one internal mammary artery? Literature review and analysis. Asian Cardiovasc Thorac Ann 2013; 21:101-13. [PMID: 23430437 DOI: 10.1177/0218492312467639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of the internal mammary artery reduces the incidence of late adverse effects and improves survival after coronary artery bypass grafting. Therefore, internal mammary artery grafts ought to be used in all patients undergoing coronary artery bypass grafting (level II evidence), although in the UK, only 95% of the patients receive an internal mammary artery graft. This is due to factors such as poor left ventricular function, old age, previous radiation to the thoracic cavity, or emergency surgery. As there are biological similarities between the left and right internal mammary artery, one can extrapolate that the use of 2 internal mammary artery grafts may provide additional benefits. Bilateral internal mammary artery grafting can be safely performed in most patients (level II evidence). The late survival in patients with bilateral internal mammary artery grafts is favorable. However, there is as yet no completed randomized trial on this subject. Thus the lack of robust data makes previous reports amenable to criticism. This review examines published data on bilateral internal mammary artery revascularization spanning the last 15 years, and addresses the advantages and disadvantages of arterial conduits in coronary surgery.
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Affiliation(s)
- Haralabos Parissis
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
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Michael TT, Banerjee S, Brilakis ES. Role of internal mammary artery bypass grafts in retrograde chronic total occlusion interventions. J Invasive Cardiol 2012; 24:359-362. [PMID: 22781479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The role of internal mammary artery grafts in facilitating retrograde chronic total occlusion interventions is controversial. We describe two cases demonstrating: (a) retrograde wiring via a left internal mammary artery graft; and (b) using the left internal mammary graft for vessel visualization while retrograde crossing to the right coronary artery was achieved via the native left main coronary artery (triple arterial access). The internal mammary artery grafts can facilitate retrograde chronic total occlusion interventions, but should be used with caution to minimize the risk of injury.
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Affiliation(s)
- Tesfaldet T Michael
- University of Texas Southwestern Medical Center and VA North Texas Healthcare System, Dallas, TX, USA
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Nezic D, Antonic Z, Bojovic Z, Milicic M, Boricic M, Kecmanovic V, Vukovic P. How to use the left internal thoracic artery which has been damaged during harvesting? Ann Thorac Surg 2012; 94:269-71. [PMID: 22734992 DOI: 10.1016/j.athoracsur.2011.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/24/2011] [Accepted: 12/06/2011] [Indexed: 11/16/2022]
Abstract
The established superiority of the internal thoracic artery as a coronary arterial conduit has led to its mandatory use in coronary artery bypass grafting surgery. Therefore, the damage of the internal thoracic artery during harvesting is an abysmal complication, after which the conduit is usually discarded. An alternative approach is presented here, which has allowed us to use the distal two thirds of the proximally damaged left internal thoracic artery as an in situ (with retrograde blood supply from superior epigastric and musculophrenic arteries), reversed arterial conduit to revascularize the left anterior descending coronary artery.
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Affiliation(s)
- Dusko Nezic
- Department of Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.
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Maltais S, Perrault LP, Sirois MG, Tanguay JF, Carrier M. Sternal neoangiogenesis following internal mammary artery devascularization: an experimental model. J Cardiovasc Surg (Torino) 2012; 53:121-126. [PMID: 22231538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The use of bilateral internal thoracic arteries (BIMA) for coronary artery revascularization is associated with better long-term survival and longer freedom from reoperation. Concerns of deep sternal wound infections and mediastinitis have constantly emerged with the utilization of BIMA grafts on a routine basis, especially in diabetic patients. METHODS We performed a quantitative evaluation of sternal bone healing and angiogenesis after left (LIMA) or bilateral internal mammary artery (BIMA) ligation two and four weeks after sternotomy in normal and diabetic Sprague-Dawley rats. RESULTS The BIMA group showed a significant increase in neoangiogenesis two weeks after surgery compared to LIMA and control groups (control: 38.3 ± 5.1 vessels/mm², LIMA: 31.4 ± 3.6 vessels/mm², BIMA: 81.6 ± 7.7 vessels/mm²; P=0.047 and P=0.04, respectively). Four weeks after the procedure, bilateral devascularization was associated with lower microvessel formation when compared to LIMA or control groups (control: 50.4 ± 5.2 vessels/mm², LIMA: 64.6 ± 4.9 vessels/mm²; BIMA: 31.5 ± 4.4 vessels/mm²; P=0.006 and P=0.02, respectively). Diabetic animals showed similar results with lower four weeks microvessel formation. However, there were no significant differences when animals with induced diabetes were compared to the normal euglycemic groups for each procedure performed. CONCLUSION BIMA ligation promotes an early increase in neoangiogenesis. Progressive sternal consolidation is associated with a significant lower level of capillaries and arterioles in the BIMA group four weeks after ligation. Diabetes did not influence the extent of neoangiogenesis between groups with similar procedures. More important clinical determinants could explain the increase incidence of sternal infection in this specific population.
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Affiliation(s)
- S Maltais
- Department of Cardiac Surgery, Montreal Cardiology Institute, Montreal, Quebec, Canada
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Halkos ME, Rab ST, Vassiliades TA, Morris DC, Douglas JS, Kilgo PD, Liberman HA, Guyton RA, Thourani VH, Puskas JD. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass for the Treatment of Left Main Coronary Stenosis. Ann Thorac Surg 2011; 92:2155-60. [PMID: 22000276 DOI: 10.1016/j.athoracsur.2011.08.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 07/29/2011] [Accepted: 08/02/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Michael E Halkos
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia30308, USA.
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Bonaros N, Schachner T, Wiedemann D, Weidinger F, Lehr E, Zimrin D, Friedrich G, Bonatti J. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and techniques from a two-center experience. Eur J Cardiothorac Surg 2011; 40:783-7. [PMID: 21459599 DOI: 10.1016/j.ejcts.2011.01.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 11/18/2022] Open
Abstract
Hybrid coronary revascularization combining minimally invasive coronary surgery and percutaneous coronary intervention (PCI) allows sternal preserving treatment of multivessel coronary disease. The main principle of the technique includes placement of mammary artery graft to the left anterior descending coronary artery (LAD) and performance of PCI in non-LAD target vessels. This principle is based on increasing data showing equivalent results of PCI with coronary revascularization using saphenous vein grafts in selected patients. Providing that perioperative and long-term results are as good as the results of conventional surgical revascularization, this option seems to be quite appealing for patients and referring cardiologists. This concept has been designed to allow rapid rehabilitation and minimize periprocedural pain under concomitant preservation of the patient's body integrity. Robotically assisted endoscopic approaches for hybrid coronary revascularization set the pace for a closed-chest treatment of multivessel coronary disease. The time point of PCI, the use of different anticoagulation protocols as well as the stent selection are some of the variables, which affect outcome. We additionally report on the midterm results of 130 after-closed-chest hybrid-coronary procedures in two institutions. Hybrid procedures using robotic technology and PCI allow closed chest treatment of multivessel coronary artery disease. Single- and double-bypass grafts are feasible and simultaneous interventions can be performed. The overall safety of the procedure seems to be adequate and perioperative clinical results are satisfactory. Intermediate term survival and freedom from angina are excellent.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Gil RJ. [Few words of interventional cardiologist about POLMIDES clinical research protocol]. Kardiol Pol 2011; 69:467. [PMID: 21594833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Robert J Gil
- Klinika Kardiologii Inwazyjnej, Centralny Szpital Kliniczny MSWiA, Warszawa
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Zembala M, Tajstra M, Zembala M, Filipiak K, Knapik P, Hrapkowicz T, Gierlotka M, Hawranek M, Poloński L, Gąsior M. Prospective randomised pilOt study evaLuating the safety and efficacy of hybrid revascularisation in MultI-vessel coronary artery DisEaSe (POLMIDES) - study design. Kardiol Pol 2011; 69:460-466. [PMID: 21594832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Hybrid coronary artery revascularisation (HCR) is a combination of minimally invasive left internal mammary artery bypass grafting to the left anterior descending artery (LAD) and percutaneous coronary interventions (PCI) with drug eluting stent implantation to other coronary arteries. Due to the paucity of data from large, prospective randomised trials comparing HCR to standard surgical revascularisation, the POLMIDES study has been designed to assess the safety and efficacy of HCR in patients with multivessel coronary artery disease (CAD) referred for standard coronary artery bypass grafting (CABG). AIM The primary objective is evaluating the feasibility and safety of HCR. METHODS Feasibility has been defined by means of the percentage of patients with a complete hybrid procedure according to the study protocol and a percentage of conversion to standard CABG. Safety has been defined as the occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeat revascularisation and major bleeding within the 12 month period after randomisation. All consecutive patients with angiographically confirmed multivessel CAD involving LAD and a critical (> 70%) lesion in at least one major epicardial vessel (except LAD) amenable to both PCI and CABG referred for conventional surgical revascularisation, will be randomised in a 1:1 fashion for HCR or standard surgical revascularisation. CONCLUSIONS The POLMIDES is a prospective, randomised pilot trial designed to determine whether HCR in patients with multivessel CAD referred for conventional CABG is safe, feasible and efficacious (ClinicalTrials.gov number, NCT01035567). Kardiol Pol 2011; 69, 5: 460-466.
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Affiliation(s)
- Marian Zembala
- Department of Cardiac Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
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Karabulut A, Teskin O. Treatment strategies for coronary lesions in Takayasu arteritis patients - case report and review of the literature. Kardiol Pol 2010; 68:1176-1180. [PMID: 20967723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Takayasu arteritis is type of vasculitis that usually affects the aorta and its major branches. While coronary involvement is seen infrequently, treatment strategy is less clear. Here, we report a case of a 45 year-old woman with Takayasu arteritis who underwent a Y-graft coronary bypass surgery four years previously. We present the long-term follow-up this patient, with a literature review. and we discuss treatment strategies.
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Affiliation(s)
- Ahmet Karabulut
- Department of Cardiology, Istanbul Medicine Hospital, Istanbul, Turkey.
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Affiliation(s)
- Arie Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Room Bd 569, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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42
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Bonatti J, Schachner T, Bonaros N, Oehlinger A, Wiedemann D, Ruetzler E, Weidinger F, Kolbitsch C, Feuchtner G, Zimrin D, Friedrich G, Pachinger O, Laufer G. Effectiveness and safety of total endoscopic left internal mammary artery bypass graft to the left anterior descending artery. Am J Cardiol 2009; 104:1684-8. [PMID: 19962475 DOI: 10.1016/j.amjcard.2009.07.051] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/14/2009] [Accepted: 07/14/2009] [Indexed: 11/27/2022]
Abstract
Totally endoscopic coronary artery bypass grafting (CABG) has become a feasible option using robotic technology and remote access perfusion techniques. The aim of this study was to determine the progression of the procedure's performance in the currently largest single-center series of arrested-heart totally endoscopic CABG. From 2001 to 2007, arrested-heart totally endoscopic CABG was performed in 100 patients (median age 59 years, range 46 to 70; 81 men, 19 women). All patients received left internal mammary artery grafts to the left anterior descending artery using the da Vinci Surgical System. Remote-access femoral perfusion and aortic balloon endo-occlusion were used in all patients. The series was divided into 4 phases: phase 1 (patients 1 to 25), phase 2 (patients 26 to 50), phase 3 (patients 51 to 75), and phase 4 (patients 76 to 100). The conversion rates to larger thoracic incisions were 7 of 25 (28%) in phase 1, 2 of 25 (8%) in phase 2, 1 of 25 (4%) in phase 3, and 1 of 25 (4%) in phase 4 (p = 0.018). Operative times and hospital stays decreased significantly with each subsequent phase, and clinical outcome showed corresponding improvements. There was no perioperative mortality. For the whole patient series, 5-year postoperative survival, freedom from angina, and freedom from major adverse cardiac and cerebral events were 100%, 91%, and 89%, respectively. In conclusion, after an initial steep learning curve, completely endoscopic left internal mammary artery-to-left anterior descending CABG can be performed safely, with low conversion rates. The learning curve for operative times and improvements in clinical outcome continued even at 100 procedures.
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Affiliation(s)
- Johannes Bonatti
- Department of Surgery, University of Maryland, Baltimore, MD, USA.
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Hynes BG, Kiernan TJ, McFadden EP. Novel management strategy for coronary steal syndrome: case report of occlusion of a LIMA graft side branch with a combination of drug-eluting and covered-stent deployment. J Invasive Cardiol 2009; 21:E218-E220. [PMID: 19901423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a novel percutaneous therapeutic approach to the management of suspected coronary artery steal syndrome resulting from a large side branch of the left internal mammary artery bypass graft, using a combination of coated and drug-eluting stents. We demonstrate the feasibility and long-term efficacy of this strategy in a case report.
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Affiliation(s)
- Brian G Hynes
- Department of Interventional Cardiology, Cork University Hospital, Wilton, Cork, Ireland.
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Krasheninnikov SV, Levit AL. [Modes of infusion provision of myocardial revascularization on the working heart]. Anesteziol Reanimatol 2009:17-19. [PMID: 20491143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The paper deals with the study of the impact of liberal (traditional) and conservative (restrictive) infusion strategy on oxygen transport, central hemodynamics, and vascular tone during myocardial revascularization on the working heart. Two patient groups intraoperatively received different infusion volumes under the control of central hemodynamic parameters by a PICCO PLUS system (Pulsion, Germany) and oxygen transport. There were no significant differences in the major parameters between the groups. However, after applying the conservative strategy, postoperative pulmonary compliance and artificial ventilation duration were less than those after liberal infusion strategy. Based on the findings, it is concluded that the restrictive infusion strategy is restrictive during myocardial revascularization on the working heart.
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Nazyrova LA, Khaĭdarov AE, Mansurov AA, Baĭbekov IM. [Effect of instrumental blood reinfusion on clinical parameters and morphology of erythrocytes during aortocoronary bypass grafting]. Anesteziol Reanimatol 2009:56-59. [PMID: 19938717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Erythrocytic morphological changes were studied in 48 patients with coronary heart disease (CHD) at the stages of coronary artery bypass grafting, in whom intraoperative continuous apparatus (CATS, Fresenius, Germany) reinfusion of lost autoblood was used. The patients with CHD were found to have a significant erythrocytic morphological transformation with the oxygen status compensated by the preserved nonpathological forms of erythrocytes. Intraoperatively stable tissue oxygen delivery and rapid blood loss compensation during coronary artery bypass grafting could be provided by continuous reinfusion of lost autoblood that contained valuable erythrocytes after apparatus elimination of disrupted and degenerative forms.
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Yuan SM, Tager S, Raanani E. Anomalous origin of the right coronary artery from the left coronary sinus. Chang Gung Med J 2009; 32:455-458. [PMID: 19664353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Surgical treatment for the anomalous origin of the right coronary artery from the left coronary sinus remains a topic of debate. A 61-year-old male patient, presenting with a single episode of chest pain, was diagnosed with anomalous origin of the right coronary artery from the left coronary sinus. The patient underwent right internal mammary artery coronary bypass surgery without ligating the proximal right coronary artery. Postoperatively, his condition remained uncomplicated and asymptomatic. Sudden death rate is high even in asymptomatic patients therefore the condition be subjected to surgical treatment after diagnosis.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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Hirnle T. [How to achieve good long term surgical results for coronary artery disease]. Kardiol Pol 2009; 67:404-405. [PMID: 19548373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Tomasz Hirnle
- Klinika Kardiochirurgii, Uniwersytet Medyczny, Białystok
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Nezic D, Knezevic A, Jovic M, Cirkovic M. Pericardial-strip technique to avoid traction on the pedicled left internal thoracic artery graft. Tex Heart Inst J 2009; 36:364-365. [PMID: 19693320 PMCID: PMC2720290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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50
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Rathore KS, Edwards J, Stuklis R. "Pulmonary slit" procedure for preventing tension on the left internal thoracic artery graft. Tex Heart Inst J 2009; 36:131-133. [PMID: 19436806 PMCID: PMC2676603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The gold-standard bypass graft to the left anterior descending coronary artery is the left internal thoracic artery harvested with its pedicle. At times, however, the length of the internal thoracic artery is insufficient for distal anastomosis. Different methods of lengthening the internal thoracic artery or of reducing the distance to the anastomosis site have been described, but at times even these may be inadequate. In order to extend the benefits of the left internal thoracic artery graft to more patients, we perform the "pulmonary slit" procedure as described here.
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Affiliation(s)
- Kaushalendra Singh Rathore
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia.
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