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At least 109 records · Page 6Linked to original sources

PubMed2000

Long-term angiographic evaluation of free internal thoracic artery grafting for myocardial revascularization.

Between 1990 and 1998, 41 patients underwent free internal thoracic artery grafting for coronary artery bypass. To investigate usefulness of free internal thoracic artery grafting, we compared the postoperative graft patency of free internal thoracic artery grafts with that of in situ internal thoracic artery grafts, and compared the long-term results such as actual survival and cardiac-event free rate in patients receiving free internal thoracic artery grafts with those results in patients receiving in situ internal thoracic artery grafts. Postoperative changes in luminal diameter of free internal thoracic artery grafts were calculated as the difference between the first and secondary angiographic evaluation in 17 patients who were followed-up for more than 5 years. The early postoperative graft patency rate of free internal thoracic artery was 95.2%. All these early patent grafts remained patent at the time of the late study. At 9 years post-surgery, patients who received free internal thoracic artery grafts had a survival rate of 100% and a cardiac event-free rate of 77.5%; the luminal diameter enlargement was 0.57 mm, and the mean matching rate increased 27.8%. We conclude that the free internal thoracic artery provides long-term results comparable with those of in situ internal thoracic artery.

Aged↗

PubMed2003

Immediate flow reserve of Y thoracic artery grafts: an intraoperative flowmetric study.

OBJECTIVES: Use of both internal thoracic arteries in a Y graft configuration can raise concerns about the possibility of the single left internal thoracic artery being able to meet the flow requirements of two or three distal territories. We evaluated intraoperatively the flow reserve of a Y thoracic artery graft distally anastomosed to the anterior and lateral territories. METHODS: In 21 patients who had Y thoracic artery grafts, the flow was measured in the main stem of the left internal thoracic artery, in the left internal thoracic artery branch, and in the right internal thoracic artery. A transit time Doppler flowmeter was used. Measurements were repeated after the injection of a bolus of 20 mug/kg dobutamine. RESULTS: At baseline condition, the mean blood flow was 44.8 +/- 24.2, 23.4 +/- 11.5, and 21.4 +/- 15.3 mL/min in the main stem of the left internal thoracic artery, in the left internal thoracic artery branch, and in the right internal thoracic artery, respectively. After dobutamine injection, these values increased to 93.2 +/- 49.8, 46.1 +/- 22.6, and 42.5 +/- 31.2 mL/min, respectively. Flow reserve was 2.1 +/- 0.6, 2.2 +/- 0.9, and 2.1 +/- 0.9 mL/min, respectively. CONCLUSIONS: Intraoperative injection of dobutamine increases the flow in the Y thoracic graft by more than two times, not only in the main stem but also in each branch. This finding attests to the safety of Y thoracic conduits in terms of hemodynamic potential.

Aged↗

PubMedDate not supplied

[Use of the internal thoracic artery in patients with stenosis of the left main branch of the coronary artery].

UNLABELLED: Internal thoracic artery (ITA) is the graft of choice in myocardial revascularization. However, superiority of the ITA graft in patients (pts) with left main coronary artery disease is still a matter of debate. PATIENTS: In the period from November 1986 through February 1999, ITA graft was used for myocardial revascularization in 2860 pts. Stenosis of the left main stem was present in 229 patients (8.0%); there were 39 women (17.0%) and 26 diabetics (11.4%). Severely depressed left ventricular function was present in 32 pts (14.0%), while the average age was 56.4 +/- 7.2 years. RESULTS: Operative mortality was 1.3% and postoperative morbidity was 5.2%. Average postoperative hospital stay was 7.9 days (6-29). There were no differences in analyzed parameters between patients who received ITA graft and similar group of 240 patients who received vein grafts only, during the same period of time. All 16 patients operated on in the period 1986-1992 (6-12 years follow-up) are alive. CONCLUSION: It is safe to use ITA graft for myocardial revascularization in patients with left main coronary artery stenosis. Early operative results are favorable and these patients should not be denied the benefit of the ITA graft, since long-term results are proved to be good as well.

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PubMed1997

Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts.

BACKGROUND: This investigation compared the incidence and the degree of atherosclerosis present in radial artery (RA) and internal thoracic artery segments remaining after coronary artery bypass grafting. METHODS: One hundred seventy specimens from 102 patients were histologically analyzed, including 106 RA specimens. RESULTS: The mean degree of pathology for the RA was 0.89 on a 0 (none) to 4 (lumen completely obliterated) scale; the mean grade of pathology for the internal thoracic artery was 0.30 (p < 0.001). Presence of diabetes, aortofemoral disease, femoral-popliteal disease, age, and male gender correlated with an increase in RA pathology. Flow in the in situ RA did not correlate with the degree of pathology. CONCLUSIONS: Study of the excess RA and internal thoracic artery segments remaining after coronary artery bypass grafting demonstrated that the RA had a higher degree of atherosclerosis than the internal thoracic artery at the time of harvest. Overall severity of disease in the RA was low. The long-term performance of RA grafts will determine whether this level of atherosclerotic disease has any clinical significance.

Arteriosclerosis↗

PubMed1999

Intraoperative and laboratory evaluation of skeletonized versus pedicled internal thoracic artery.

BACKGROUND: The skeletonization of internal thoracic artery is postulated to improve graft length, early blood flow, sternal blood supply, and postoperative respiratory function. Concern exists that skeletonization may injure internal thoracic artery, precluding good results of surgery. Reports on endothelial function of skeletonized internal thoracic artery are lacking. METHODS: A prospective assessment of early clinical outcomes of 357 consecutive patients undergoing coronary artery bypass grafting was performed: 287 patients with nonskeletonized and 70 with skeletonized left internal thoracic artery (LITA). The lengths of LITA and of its discarded distal segment, as well as free LITA blood flow, were measured. The dose-effect relationship for relaxation to acetylcholine was studied in the organ bath. RESULTS: Apart from a higher incidence of breaching the pleura with nonskeletonized LITA the clinical outcomes were comparable. The length of skeletonized LITA was 17.8+/-1.14 cm versus 20.3+/-0.52 cm skeletonized (p = 0.11). The length of discarded LITA was shorter in nonskeletonized artery (0.8+/-0.28 cm versus 2.6+/-0.49 cm; p = 0.022). The free LITA blood flow was 66.3+/-7.42 mL/min in nonskeletonized vessel versus 100.3+/-14.84 mL/min in skeletonized (p = 0.048). The acetylcholine-induced relaxation was similar in both groups (maximal relaxation, 80.7%+/-5.95% in nonskeletonized versus 72.9%+/-9.11% in skeletonized; not significant; negative logarithm of half-maximal effect, 7.43+/-0.18 versus 7.1+/-0.10, respectively; p = 0.063). CONCLUSIONS: Skeletonization does not damage the endothelial function of the LITA. Higher free blood flow and available LITA length should encourage the use of skeletonized LITA in clinical practice.

Acetylcholine↗

PubMed2000

Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft.

BACKGROUND: The prevalence of intercostal nerve damage associated with coronary artery bypass graft-internal thoracic (mammary) artery surgery is unknown. METHODS: A total of 37 consecutive patients with coronary artery bypass graft surgery (all with left internal thoracic artery graft) who were attending a cardiac-related exercise program underwent a thorough examination. Nerve damage was considered to be "definite" in the presence of two consistent and well-demarcated sensory abnormalities over the anterior chest wall within the T1 to T6 anterior intercostal nerve territory, and was considered "possible" in the presence of one such abnormality. RESULTS: Definite nerve damage was detected in 73% of the subjects, and possible nerve damage was found in another 11% at the site of internal thoracic artery harvesting. Protracted postoperative pain or unpleasant sensations, usually subsiding by 4 months, were reported by recollection by 81% of the subjects. Overall, the prevalence of persistent pain in those with definite nerve damage 5 to 28 months after surgery was 15%. CONCLUSIONS: Intercostal nerve damage seems to occur in three-quarters of all patients undergoing coronary artery bypass graft-internal thoracic artery surgery. A significant minority may continue to experience bothersome chronic chest wall pain.

Aged↗

PubMed1988

Carbodissection of the internal thoracic artery pedicle.

Carbodissection of the internal thoracic artery pedicle facilitates separation of the internal thoracic artery from the chest wall and permits rapid atraumatic exposure of its branches for precise clipping under direct vision, without the risks of thermal injury inherent in cautery dissection of the pedicle. Twenty-four internal thoracic arteries have been prepared for coronary artery bypass grafting using carbodissection, with no complications and an average operating time of 19.8 minutes.

Carbon Dioxide↗

PubMed2004

Single versus bilateral internal thoracic artery grafts with concomitant saphenous vein grafts for multivessel coronary artery bypass grafting: effects on mortality and event-free survival.

BACKGROUND: The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the long-term outcome of single and bilateral internal thoracic artery grafting with concomitant saphenous vein grafting for multivessel coronary artery bypass grafting. METHODS: Between March 1985 and April 1995, 6650 patients underwent primary isolated coronary artery bypass grafting with internal thoracic artery grafts, including 4382 patients with multivessel bypass grafting requiring at least 3 grafts. Outcomes of patients undergoing single internal thoracic artery plus saphenous vein grafting (n = 2547) and bilateral internal thoracic artery plus saphenous vein grafting (n = 1835) were obtained at a mean follow-up of 11 +/- 3 years. RESULTS: Patients with bilateral internal thoracic artery grafting were younger, were mostly male, and had less diabetes, hypertension, unstable angina, and recent myocardial infarction than patients undergoing single internal thoracic artery grafting. Thirty-day mortality was 2.3% for the group undergoing single internal thoracic artery grafting versus 1.2% for those undergoing bilateral internal thoracic artery grafting (P =.007). Survival probability at 10 years was 88% for the single-graft group compared with 93% for the bilateral-graft group (P <.001). Multivariate analysis with propensity scoring showed that bilateral internal thoracic artery grafting decreased the risk of death (hazard ratio, 0.74; 95% confidence interval, 0.60-0.90), myocardial infarction (hazard ratio, 0.79; 95% confidence interval, 0.67-0.93), and coronary reoperation (hazard ratio, 0.41; 95% confidence interval, 0.21-0.80) throughout the follow-up period. Other significant predictors of death were diabetes, prior myocardial infarction, need for intra-aortic balloon pump, chronic heart failure, and peripheral vascular disease. CONCLUSION: Patients undergoing bilateral internal thoracic plus saphenous vein grafting appear to have a significantly better long-term clinical outcome than patients undergoing single internal thoracic artery plus saphenous vein grafting for multivessel coronary artery bypass grafting.

Coronary Artery Bypass↗

PubMed2003

Technical aspects of composite arterial grafting with double skeletonized internal thoracic arteries.

BACKGROUND: Complete myocardial revascularization with internal thoracic arteries (ITAs) improves long-term survival and decreases the rate of repeat operations, compared to vein grafts. Adequate length of the graft in coronary artery bypass graft (CABG) surgery is essential for providing complete arterial revascularization. Extra length can be obtained by skeletonization of both ITAs. In cases where the right ITA (RITA) is too short to bridge the distance to the target anastomotic site, it is used as a free graft in "composite" arterial grafting, a surgical technique in which free arterial conduits are proximally anastomosed end-to-side to an intact ITA. OBJECTIVES: To describe alternative surgical procedures adapted to accommodate special anatomic requirements. DESIGN: Retrospective study from April 1996 to April 1999. PATIENTS: One thousand fifty patients underwent CABG surgery using bilateral skeletonized ITAs: 650 patients (482 men and 168 women; mean +/- SD age, 69 +/- 7 years) underwent composite arterial grafting. Two hundred sixteen patients (33.2%) were diabetics, 87 patients (13.4%) had severe left ventricular dysfunction (ejection fraction < 35%), and 27 patients (4.2%) underwent emergency operations. INTERVENTIONS: The RITA was used as a free graft connected to the in situ left ITA (LITA) in 618 patients. A free LITA was attached to in situ RITA in 32 patients, and minicomposite grafts (free distal LITA on the LITA or free distal RITA on the RITA) were constructed in 38 patients. The average number of grafts was 3.2 per patient (range, 2 to 6 grafts per patient). MEASUREMENTS AND RESULTS: Operative mortality was 2.9% (n = 19), and there were 11 sternal wound infections (1.7%). Early recatheterization was performed in 41 symptomatic patients. The patency rate was 95%. The mean follow-up was 25 months (range, 14 to 36 months), and the 3-year survival was 92.5%, with 97% of the surviving patients being angina free. CONCLUSIONS: Planning CABG surgery using bilateral skeletonized ITAs as arterial conduits affords greater choice in grafting approaches, especially when a composite technique is feasible.

Aged↗

PubMed2003

Non-invasive assessment of the composite radial artery and in situ left internal thoracic artery Y-graft for myocardial revascularization.

BACKGROUND: It is controversial whether composite arterial grafts can provide adequate blood flow for myocardial revascularization. We assessed at transthoracic echography and myocardial scintigraphy the composite radial artery-in situ left internal thoracic artery Y-graft. METHODS: In 32 of 36 consecutive patients who underwent myocardial revascularization using this composite arterial graft, successful postoperative transthoracic images of the main stem of the Y-graft were obtained at rest and early after standard exercise. The main stem diameter, cross-sectional area and blood flow velocity and volume were measured. The coronary flow reserve (CFR) was calculated. The patients were divided into three groups according to the number of coronary artery systems bypassed with the Y-graft: group I included 11 patients with one coronary system bypassed, group II 18 patients with two, and group III 3 patients with three coronary systems bypassed. In 14 patients myocardial scintigraphy was performed at rest and after stress. RESULTS: After exercise, the diameter, cross-sectional area, and blood flow velocity and volume increased. The mean CFR in group III was greater than in group I (p = 0.00045) and in group II (p = 0.049). In 2 patients, the nuclear stress test was positive (reversible ischemia in the distribution area of the Y-graft) and the mean CFR was lower than in the patients with a negative nuclear stress test (p = 0.046). CONCLUSIONS: This composite arterial graft is a compliant conduit, able to regulate its flow capacity to myocardial demand. Non-invasive assessment of this Y-graft using transthoracic echography is possible, and correlates with the results of myocardial scintigraphy.

Adult↗

PubMed2001

Morphological differences of the internal thoracic artery in patients with and without coronary artery disease--evaluation by duplex-scanning.

OBJECTIVE: The internal thoracic artery is an established arterial graft for myocardial revascularisation, especially of the left anterior descending artery because of a higher patency rate compared to venous grafts. It has never been investigated, whether there are morphological differences in this vessel between patients with or without coronary artery disease or if they are comparable to morphological changes in the common carotid artery. METHODS: We investigated the internal thoracic artery and the common carotid artery of 24 patients (12 with coronary artery disease, 12 without coronary artery disease) with an ultrasonic system on both sides. The intima-media thickness and the diameter of both vessels were estimated. RESULTS: The intima-media-thickness of the internal thoracic artery was comparable in all patients, independent of the presence of a coronary artery disease (0.51+/-0.11 mm with coronary artery disease, 0.50+/-0.17 mm without coronary artery disease, P>0.05). Compared with this the intima-media-thickness of the common carotid artery was thicker in patients with coronary artery disease (0.84+/-0.13 mm with coronary artery disease, 0.73+/-0.07 mm without coronary artery disease, P< or or =0.014). There was no correlation between the thickness of the internal thoracic artery and the common carotid artery (r=0.018, P>0.05). CONCLUSIONS: It could be demonstrated for the first with non-invasive ultrasound, that the intima-media-complex of the internal thoracic artery is protected of the influence of arteriosclerosis. There are no morphological differences like the intima-media-thickness of the common carotid artery. The proven protective mechanism underlines the widespread use of the internal thoracic artery as a coronary artery bypass graft.

Aged↗

PubMed1994

Internal thoracic artery graft holder for coronary artery bypass grafting.

An internal thoracic artery graft holder, designed for use during coronary artery bypass grafting, is described. This new holder is atraumatic and holds the internal thoracic artery graft securely during anastomosis. The use of this instrument facilitates the use of an arterial graft for coronary artery bypass grafting.

Coronary Artery Bypass↗

PubMed2000

[How I investigate ... thoracic artery dissection].

Thoracic aortic dissection constitutes an acute pathology that requires a rapid, accurate and reliable diagnosis. The authors describe and illustrate the advantages and limitations of imaging modalities used in this pathology.

Aortic Dissection↗

PubMed1992

A quantitative study of postoperative luminal narrowing of the internal thoracic artery graft in coronary artery bypass surgery.

We used quantitative angiography to determine the postoperative diameter of the internal thoracic artery graft at the point close to the anastomosed site in 147 patients who received the graft for the left anterior descending coronary artery. We performed generalized multiple linear regression analysis (Type I quantification method) to assess the effects of the following factors on the internal thoracic artery graft diameter: age, gender, time of angiography, laterality of the internal thoracic artery used, presence of an undivided major side branch of the internal thoracic artery, presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft, presence of distal stenosis of the recipient left anterior descending coronary artery, severity of postoperative left anterior descending coronary artery stenosis, and presence of coronary risk factors. The standardized category scores for 25% left anterior descending coronary artery stenosis, 50% left anterior descending coronary artery stenosis, and presence of a saphenous vein graft having blood flow competition with an internal thoracic artery graft were -1.418, -0.767 and -0.622, respectively. Thus, the internal thoracic artery diameter was smaller in patients with well-preserved flow of the recipient coronary artery. The internal thoracic artery diameter had a particularly strong correlation with the degree of left anterior descending coronary artery stenosis (partial correlation coefficient: 0.670). The other factors seemed to have little or no correlation with the postoperative internal thoracic artery diameter. With the criterion that the internal thoracic artery diameter below 1.0 mm represents the "string sign" of internal thoracic artery graft, this phenomenon was observed in nine patients (6.1%). In all of these patients, left anterior descending coronary artery flow was well-preserved, and no ischemia was disclosed in the left anterior descending coronary artery-perfused area. These results indicate that internal thoracic artery grafts have flow adaptability responding to the flow demand of the recipient coronary artery and that the string sign of internal thoracic artery grafts is mainly an outcome of its physiologic characteristics.

Adult↗

PubMed2005

Internal thoracic artery: to skeletonize or not to skeletonize?

The internal thoracic artery has been the most reliable graft material used in coronary artery bypass grafting with an excellent long-term patency rate. Complete myocardial revascularization with internal thoracic arteries improves long-term survival and decreases the rate of repeat operations compared with vein grafts. Adequate length of the graft in coronary artery bypass graft surgery is essential for providing complete arterial revascularization. In the last decade or so, technique of skeletonization of internal thoracic artery has been proposed to achieve extra length. Skeletonization of the internal thoracic artery allows the preparation of longer conduits with a superior free flow and can reduce the incidence of postoperative pulmonary and sternal complications. However, concerns about vasoreactivity of skeletonized internal thoracic artery grafts, the functional consequences of surgical trauma, the possible loss of innervation, and vasa vasorum perfusion in the skeletonized conduits have prevented this technique from being universally accepted. Presently available evidence from retrospective studies (level 3 evidence) suggests that skeletonization is a safe and effective technique for myocardial revascularization. However, there is a need for conducting multicenter, randomized controlled trials comparing the skeletonized and pedicled internal thoracic arteries with special emphasis on long-term patency to conclusively validate the safety and efficacy of skeletonization technique.

Angioplasty, Balloon, Coronary↗

PubMed1999

[Minimally invasive coronary artery bypass (MIDCAB) for double vessel using Y arterial graft which consists of left internal thoracic artery and right inferior epigastric artery].

MIDCAB is a rapidly evolving technique to revascularize the left anterior descending coronary artery (LAD) with the left internal thoracic artery (LITA). Our case is a 60-year-old female with unstable angina due to restenosis of the proximal LAD following PTCA and proximal stenosis of the large first diagonal branch (D1). She underwent double vessel MIDCAB (LITA-LAD and LITA-RIEA-D1) using Y composite arterial conduit with LITA and right epigastric artery (RIEA), because of chronic renal failure on maintenance hemodialysis. Postoperative course was uneventful and postoperative angiography revealed a patent Y graft. Y graft using IEA appears to be an interesting operative method in double vessel MIDCAB.

Coronary Artery Bypass↗

PubMed1994

[Principles of duplex ultrasound diagnosis of the internal thoracic artery].

Because of its better long term patency the internal thoracic artery has become the conduit of choice for myocardial revascularization. Thirty healthy young volunteers were investigated to prove the suitability of the duplex system for investigating the internal thoracic artery. The mean systolic peak flow velocity was 1.15 m/s in the proximal vessel decreasing to 0.55 m/s in the peripheral course of the artery. Mean internal thoracic artery diameters at the origin were calculated as 2.18 mm for the left and 2.43 mm for the right internal thoracic artery. The flow curves represent those of elastic-type vessels, whereas in a small number resistance curves occurred representing the muscular type. The combination of two-dimensional B-mode and Doppler unit allows visualization of the internal thoracic artery and assessing the flow velocities within the vessel. Ultrasonic duplex scanning is a noninvasive diagnostic tool for investigation of the internal thoracic artery.

Adult↗

PubMed2002

Effects of cerivastatin on vascular function of human radial and left internal thoracic arteries.

BACKGROUND: Statins may enhance vascular function independently of effects on cholesterol. This study investigated the ability of statins to modulate the vascular recovery of arteries used as coronary bypass grafts. METHODS: Specimens of radial artery and left internal thoracic artery were obtained during coronary artery bypass grafting. The specimens were divided into vascular rings, which were incubated in the absence or presence of cerivastatin (10(-6) mol/L) for either 2 or 24 hours. Using an organ bath technique, endothelial function was examined using acetylcholine (10(-9) to 10(-5) mol/L) after contraction by 3x10(-8) mol/L of endothelin-1. RESULTS: Time-related endothelial dysfunction was shown in the control group of radial artery but not in the cerivastatin group: maximal endothelium-dependent vasodilation in the control and cerivastatin groups were 56.8% +/- 10.2% and 65.9% +/- 10.1% at 2 hours and 39.4% +/- 4.7% and 68.4% +/- 5.0% (p < 0.01, vs control) at 24 hours, respectively. On the other hand, in the left internal thoracic artery, those in the control and cerivastatin groups were 38.3% +/- 8.2% and 45.0% +/- 5.5% at 2 hours and 38.1% +/- 8.2% and 56.5% +/- 8.8% at 24 hours, respectively (NS). CONCLUSIONS: In radial artery, cerivastatin significantly preserved endothelium-dependent vasodilation, which diminished with time in the control group. This could have very important implications in the clinical practice of coronary artery bypass grafting.

Adult↗