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At least 127 records · Page 7Linked to original sources
PubMed2000

All-artery multigraft coronary artery bypass grafting with only internal thoracic arteries possible and safe: a randomized trial.

BACKGROUND: The internal thoracic artery (ITA) bypass to the left anterior descending coronary artery is of proven benefit in multigraft coronary artery bypass. Total ITA grafts, if reoperation is averted by avoiding saphenous vein grafts (SVGs), are attractive. The safety of the total ITA graft operation (all-ITA) is a concern. METHODS: A randomized trial of multiple-ITA bypass graftings with the use of bilateral sequential ITA without SVGs was performed. Control patients received 1 ITA plus SVG. Inclusion criteria were those used in the Coronary Artery Surgery Study, extended to age 76 years, and any angina class, except emergent. One hundred sixty-two patients were randomized (81 patients per group) from January 1, 1990, to December 31, 1994. RESULTS: Baseline traits were similar as were cross-clamp times, pump times, and number of arteries bypassed (average, 4.3 arteries). Patients who received multiple ITA grafts had no myocardial infarctions, per reference laboratory. One patient died, and 2 patients returned for bleeding. The ITA-SVG group had similar results. The all-ITA group experienced successful completion in 93% of cases. Complications did not differ from control patients. CONCLUSIONS: Early and 5-year outcomes were not different between the all-ITA group and the ITA with SVGs group. We believe experienced surgeons can safely extend the ITA to multibypass coronary artery bypass without use of SVG to achieve an all-ITA operation.

Aged↗
PubMed2005

The effect of bilateral internal thoracic artery harvesting on superficial and deep sternal infection: The role of skeletonization.

OBJECTIVE: To determine the relative risk of sternal dehiscence in patients undergoing bilateral internal thoracic artery harvesting and to assess whether and to what extent the technique of artery skeletonization might reduce this risk. METHODS: Prospectively collected data on patients undergoing coronary artery bypass operations with at least a single internal thoracic artery were reviewed. The last 450 patients receiving bilateral internal thoracic artery grafts were compared with 450 patients who received a single internal thoracic artery during the same period. The left internal thoracic artery was always harvested in a pedicled fashion. Among patients receiving a bilateral internal thoracic artery, both arteries were harvested in a pedicled fashion in 300 cases, whereas both internal thoracic arteries were skeletonized in the remaining 150 cases. RESULTS: Compared with a single internal thoracic artery, harvesting both internal thoracic arteries either in a skeletonized or in a pedicled fashion increased the chance of deep (1.1% vs 3.3% vs 4.7%; P = .01) or superficial (4.8% vs 7.8% vs 12%; P = .002) sternal infection. However, the technique of artery harvesting (odds ratio, 4.1; 95% confidence interval, 1.4-12.1); the presence of peripheral arteriopathy (odds ratio, 3.1; 95% confidence interval, 1.2-8.5), and resternotomy for bleeding (odds ratio, 8.2; 95% confidence interval, 2.0-33.6) were the only independent predictors for deep sternal infection, whereas the technique of artery harvesting (odds ratio, 3.0; 95% confidence interval, 1.6-5.4), female sex (odds ratio, 2.2; 95% confidence interval, 1.2-4.2), and diabetes (odds ratio, 1.7; 95% confidence interval, 1.0-2.9) were the only independent predictors of superficial sternal infection. In diabetic patients, there was no difference in the incidence of deep sternal infection among patients receiving a single internal thoracic artery or double skeletonized internal thoracic arteries ( P = .4). CONCLUSIONS: Bilateral internal thoracic artery harvesting carries a higher risk of sternal infection than harvesting a single internal thoracic artery. Skeletonization of both internal thoracic arteries significantly decreases this risk. A strategy of bilateral thoracic artery grafting can also be offered to patients at high risk for wound infection.

Aged↗
PubMed2000

Complete myocardial revascularization with bilateral internal thoracic artery T graft.

BACKGROUND: The internal thoracic artery is widely recognized as the ideal graft for coronary artery bypass procedures. However, because of the inadequate length of the conduit, use of bilateral internal thoracic artery grafting was not suitable for complete revascularization. To overcome this limitation, the T graft was introduced in the 1990s. We decided to prospectively assess the safety of this technique. METHODS: One hundred six patients with a mean age of 51.5 years underwent complete revascularization with an internal thoracic artery T graft. Mean left ventricular ejection fraction was 0.60 (range, 0.22 to 0.85). RESULTS: No patient required reexploration for bleeding, and no patient died within 30 days after operation. On the basis of electrocardiographic changes, 3 patients sustained a perioperative myocardial infarction. One patient had a sternal wound infection. Mean follow-up was 35 months (range, 15 to 61 months). The actuarial survival rate was 99% +/- 1% at 5 years. No myocardial infarctions were reported during the follow-up. Seven patients had recurrent angina. Eighty patients (76%) underwent postoperative stress tests, and 90% had negative results. CONCLUSIONS: Complete myocardial revascularization with the T graft is a safe and reliable technique with excellent midterm results.

Adult↗
PubMed1994

The Y graft: myocardial revascularization with both internal thoracic arteries. Evaluation of eighty cases with coronary angiographic assessment.

The use of bilateral in situ internal thoracic arteries is restricted by the risk of sternal devascularization, the length of the pedicle, and the necessity to avoid crossing the midline. The aim of this study is to evaluate Y grafts achieved by anastomosing the proximal end of the free right internal thoracic artery to the side of the attached left internal thoracic artery. Y grafts were performed in 80 patients, aged 41 to 74 years (mean age 58.6 years) between May 1991 and September 1992. Two different techniques were used. Thirty-four patients were included in group 1 and 46 in group 2. Seventy-nine grafts were performed from the left internal thoracic artery to the left anterior descending artery. The right internal thoracic artery was anastomosed to the diagonal artery (5 times), the marginal branch (67 times), the circumflex artery (7 times) and the right coronary artery (2 times). Seventy-five complementary saphenous vein bypasses were performed in 58 patients. Operative mortality was 2.5%. Two patients had perioperative myocardial infarcts (2.5%) on nonbypassed sites. Three patients had sternal wound infections (3.7%). Sixty-two patients (80%) were reexamined by angiography at month 6-25 in group 1 and 37 in group 2. Sixty left internal thoracic artery bypass grafts (97%) were patent versus 39 right internal thoracic artery bypass grafts (63%). In group 1, 23 of 25 left internal thoracic artery bypass grafts were patient (92%) versus 12 right internal thoracic artery grafts (48%). In group 2, all 37 left internal thoracic artery bypass grafts were patent (100%) versus 27 right internal thoracic artery grafts (73%). With this procedure, particular attention must be paid to the length of the right internal thoracic artery, and extensive training is required.

Adult↗
PubMed2001

Impact of double internal thoracic artery grafts on long-term outcomes in coronary artery bypass grafting.

We performed this study to determine if bilateral internal thoracic artery grafts provide greater benefit than single internal thoracic artery grafts. Six hundred ninety-four consecutive patients who received 2 coronary grafts in a single operation during 1983-1989 were given 10 years of follow-up and then analyzed retrospectively. Group 1 (n=382) received 2 internal thoracic artery grafts, Group 2 (n= 139) received 1 internal thoracic artery graft and 1 saphenous vein graft, and Group 3 (n= 173) received 2 saphenous vein grafts. Patient demographics, preoperative angiographic findings, and operative indications were the same. Hospital mortality rates were 2.6%, 2.2%, and 2.3%, respectively. Hemorrhage, sternal wound infection, mediastinitis, sternal dehiscence, and prolonged ventilatory support showed no group differences. Follow-up over 10 years was complete in 677 survivors. Mortality rates during follow-up were 1.8%, 2.9%, and 4.7%, respectively. Cardiac-related mortality rates were 71%, 75%, and 88%, respectively (Group 1 vs Group 3, P=0.0412). Ten-year survival was better for Group 1 than for Groups 2 and 3 (P=0.0356 and P <0.0001). Cardiac-event-free survival at 10 years was 93% in Group 1, 84% in Group 2, and 74% in Group 3 (all P <0.0001). The use of 2 internal thoracic artery grafts resulted in significantly lower risk of cardiac death and re-intervention, compared with the use of 1 internal thoracic artery, which in turn was superior to the use of vein grafts. Use of double internal thoracic arteries did not increase postoperative complications.

Adult↗
PubMed1999

In situ right internal thoracic artery graft for revascularization of circumflex artery. Early results and long-term angiographic follow up.

In 285 patients, the right internal thoracic artery, routed through the transverse sinus, was in most cases anastomosed to the circumflex branches. In 278 cases, the left internal thoracic artery was simultaneously used for revascularization of the left anterior descending artery. Two patients died (mortality rate 0.7%). Postoperative early angiography on 278 patients revealed a high graft patency of 97.8% for the right internal thoracic artery and 96.9% for the left internal thoracic artery. A long-term follow-up study was performed on the first consecutive 115 patients who survived the operation. Seven patients died, 2 due to cardiac causes. Angiographic assessment was performed in 73 patients (67%) at an interval of 28.8 to 93.1 months (mean 58.9 months). Five right internal thoracic arteries were occluded and sledlike right internal thoracic artery grafts were present in 2 patients. Two of them had been confirmed in the previous early study to be not patent. Insufficient data was obtained in 4 patients. The perfect patency rate of the right internal thoracic artery was 89.9% (62/69). Five left internal thoracic arteries were occluded, providing a perfect patency rate of 92.3%. There was no significant difference between the success rate using the right internal thoracic artery and that resulting from using the left internal thoracic artery. We conclude that coronary revascularization using this technique provides good clinical results and excellent early and late patency of the right internal thoracic artery.

Adolescent↗
PubMed1999

[Reoperative off-pump subclavian-coronary artery bypass grafting in an elderly patient with left internal thoracic artery stenosis].

A 80-year-old Japanese female was diagnosed to have angina pectoris and admitted to our hospital. She had been operated on with mitral valve replacement and coronary artery bypass grafting to right and circumflex coronary artery 4 years before. The coronary angiogram showed significant stenosis with severe calcification in the left anterior descending coronary artery, and it was unsuitable for catheter intervention. The patient also had stenotic left internal thoracic artery and multiple cerebral infarction, but successful off-pump subclavian-coronary artery bypass grafting using saphenous vein graft through small thoracotomy was performed without new neurological deficit. This procedure is useful for patients with left internal thoracic artery unsuitable for MIDCABG, due to quality, size, or injury during preparation.

Aged↗
PubMed1990

[Clinical results, graft patency and flow reserve capacity of multiple coronary artery bypass with bilateral or sequential internal thoracic artery grafts].

Multiple coronary artery bypass grafting (CABG) was performed utilizing the internal thoracic arteries (ITA) in 87 patients ranging in age from 3 to 76 years. Bilateral ITAs were used in 67, sequential grafting was performed in 16, and the combination of both techniques was applied in 4 patients. Twelve patients had coronary arterial obstructions due to Kawasaki disease (mean age 9.7 +/- 3.3 years) and the remaining 75 patients had atherosclerotic coronary artery disease (mean age 53 +/- 10 years). Triple vessel disease and left main trunk disease occupied 85% of the patients. The number of grafts was 2 to 5 per patient with an average of 3.2 +/- 0.7 per patient. In bilateral ITA grafting, the combination of the RITA to LAD and LITA to LCX was most frequently used, and in sequential grafting, the LITA-diagonal artery-LAD was the most common use. There were no early or late mortalities in the present series. The patency rates for the RITA and LITA were 93% and 96%, respectively, and those of sequential grafting were 100% in both the proximal and distal anastomoses. The clinical outcome of multiple CABG with ITAs was quite satisfactory, and the bilateral ITAs could be used in the very wide range of patient's age from 3 to 76 years. In addition, blood flow reserve provided by bilateral ITAs was equivalent to that of the SVG alone or SVG plus ITA on the basis of the result of coronary sinus flow (CSF) measurements during exercise, and thus complete revascularization of the left ventricle could be accomplished by multiple CABG with ITAs.

Adult↗
PubMed1997

Medium-term patency and anatomic changes after direct bronchial artery revascularization in lung and heart-lung transplantation with the internal thoracic artery conduit.

OBJECTIVE: Our purpose was to study the 2-year patency of direct bronchial artery revascularization in lung transplantation. We wanted to clarify whether the revascularized bronchial artery system is functional after 2 years, whether bronchial artery vascularity changes with time, and whether posttransplantation bronchial artery disease is arteriographically evident after 2 years. METHODS: Bronchial artery revascularization is performed by anastomosing the internal thoracic artery to as many bronchial artery orifices in the donor descending aorta as possible. Twenty-three patients surviving 2 years or more have had internal thoracic artery-bronchial arteriography performed 1 month and 2 years after transplantation. One-month and 2-year arteriograms have been compared. RESULTS: Two-year patency of the internal thoracic artery conduit was 100%. The appearance of the bronchial arteries was unchanged after 2 years in 11 patients. A unilateral or bilateral increase in vascularity was found in two and seven patients, respectively. In three patients new vessels, not visible on the first arteriogram, had appeared. In four patients one or more small vessels visible on the first arteriogram had disappeared on the second arteriogram. We have found no arteriographic signs of bronchial artery disease, such as stenosis of the bronchial arteries, and no arteriographic evidence of arteriosclerotic disease in the internal thoracic artery. CONCLUSION: The internal thoracic artery is an excellent conduit for bronchial artery revascularization, with a 2-year patency of 100% in 23 patients. Only minor changes in the bronchial arteriograms have been found.

Bronchial Arteries↗
PubMed2006

Prospective angiographic comparison of direct, endoscopic, and telesurgical approaches to harvesting the internal thoracic artery.

BACKGROUND: The purpose of this study was to compare the quality of left internal thoracic arteries harvested by the conventional open approach versus minimally invasive videoscopic and robotic-assisted telesurgical techniques. METHODS: One hundred and fifty consecutive patients with single vessel coronary artery disease were prospectively studied. The left internal thoracic artery was harvested using three different approaches, with 50 patients consecutively assigned to each group. The off-pump coronary artery bypass (OPCAB) group underwent median sternotomy with direct visualization. The automated endoscopic system for optimal positioning (AESOP) group employed the AESOP 3000 system (Computer Motion Inc, Goleta, CA) for robotic-assisted visualization with endoscopic manual left internal thoracic artery harvesting. The Zeus group used the Zeus robotic telesurgical system (Computer Motion Inc) and internal thoracic artery harvesting was performed remotely from a surgical console. Postanastomotic left internal thoracic artery flows and day one postoperative angiography were used to assess internal thoracic artery quality and patency. RESULTS: Average left internal thoracic artery harvest times were 23 +/- 2.5, 63.3 +/- 20.3, and 66.1 +/- 17.9 minutes in the OPCAB, AESOP, and Zeus groups, respectively (p < 0.001, OPCAB vs AESOP and Zeus). Intraoperative graft flows averaged 28.1 +/- 11.9, 33.7 +/- 19.3, and 36.9 +/- 24.6 mL/minute, respectively in the OPCAB, AESOP, and Zeus groups (p = 0.317, OPCAB vs AESOP and Zeus). There was no significant angiographic difference in the patency rate of the harvested left internal thoracic arteries in the three groups (p = 0.685, overall). CONCLUSIONS: The left internal thoracic artery can be harvested safely and effectively using minimally invasive videoscopic and robotic-assisted telesurgical techniques. Although the less invasive approaches require specialized equipment and training as well as increased operative time, they offer the potential for less traumatic myocardial revascularization through smaller incisions and reduced postoperative morbidity.

Adult↗
PubMed1998

Preoperative and early postoperative assessment of the internal thoracic artery by transcutaneous duplex ultrasound in coronary artery bypass grafting.

We examined internal thoracic artery by transcutaneous duplex ultrasound in 26 patients on four occasions: 4 (+/-2) days before the operation, and 61 (+/-8) minutes, 5 days and 53 (+/-3) days postoperatively. There was dominant systolic flow in preoperative scans. After the operation a characteristic biphasic flow with increased peak diastolic velocity and a decrease in peak systolic/peak diastolic velocity ratio was detected in all patients. The pulsed Doppler spectrum was used to measure peak velocity, time averaged mean velocity and time averaged maximum velocity. Resting internal thoracic artery flows calculated using time averaged mean velocity were 30.9+/-5.4 ml/min preoperatively, 40.7+/-6.3 ml/min immediately after surgery, 41.1+/-8.2 ml/min at 5 days and 40.1+/-4.9 ml/min at 53 days. There were no significant changes in resting internal thoracic artery flow between early and late postoperative studies. Flow estimates calculated using 0.5 x time averaged maximum velocity or time averaged mean velocity showed good agreement. Early postoperative measurements appear to be a good predictor of later resting graft flow.

Aged↗
PubMed2001

Chymase-dependent angiotensin II formation in the saphenous vein versus the internal thoracic artery.

OBJECTIVES: The great saphenous vein graft is known to be less patent than the internal thoracic artery graft. Recently, we reported that chymase-dependent angiotensin II formation plays an important role in the development of intimal hyperplasia in dog grafted veins. In this study we investigated the levels of angiotensin II-forming enzymes, angiotensin-converting enzyme, and chymase in human saphenous veins and internal thoracic arteries. METHODS: The saphenous vein and internal thoracic artery specimens were obtained from coronary artery bypass grafts of patients during surgical procedures (saphenous vein, n = 16; internal thoracic artery, n = 16). Activities of angiotensin-converting enzyme and chymase were determined by using the extract from the saphenous vein or internal thoracic artery. Sections of the saphenous vein or internal thoracic artery were stained with van Gieson's elastin stain and were immunostained with anti-human chymase antibody. RESULTS: The activities of angiotensin-converting enzyme in the saphenous vein and internal thoracic artery were 0.34 +/- 0.12 and 0.32 +/- 0.17 mU/mg protein, respectively, and the difference was not significant. The chymase activity in the saphenous vein was significantly higher than that in the internal thoracic artery (saphenous vein, 10.1 +/- 0.81 mU/mg protein; internal thoracic artery, 6.21 +/- 1.86 mU/mg protein). Chymase-positive cells in the saphenous vein were located in both the media and adventitia, and those in the internal thoracic artery were located only in the adventitia. The number of chymase-positive cells in the saphenous vein was about 2.6 times that in the internal thoracic artery. CONCLUSION: The chymase activity, but not the angiotensin-converting enzyme activity, was significantly higher in the saphenous vein, suggesting that the high levels of chymase activity may be related to the poorer performance of the saphenous vein for use as a bypass conduit.

Aged↗
PubMed2004

Effect of carbon dioxide insufflation on free internal thoracic artery flows: is it a vasodilator?

BACKGROUND: This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows. METHODS: We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive internal thoracic arteries were harvested as a pedicled graft (group 1), and the next 30 consecutive internal thoracic arteries were dissected by using the carbon dioxide insufflation technique (group 2). The internal thoracic artery harvesting was performed by 2 experienced surgeons by using the same instrumentation and technique. First, free flows of the internal thoracic arteries were registered after distal cutting of the vessel in both groups. After the first measurements, diluted papaverine was sprayed on the internal thoracic artery pedicle only in group 1, and then second measurements were registered after 15 minutes in both groups. Hemodynamic parameters were recorded with each measurement. RESULTS: The first free flow measurement was significantly higher in the carbon dioxide-insufflated internal thoracic arteries (group 2, 60 +/- 32 mL/min; group 1, 28 +/- 19 mL/min; P <.05). Although the second free flow measurement of the carbon dioxide-insufflated group was higher than in group 1, the difference was not statistically significant (68 +/- 46 mL/min vs 53 +/- 32 mL/min; P =.53). CONCLUSIONS: Carbon dioxide insufflation of the internal thoracic artery is an efficient technique to increase the flow and seems to be safe, simple, and reliable. When the internal thoracic artery is harvested in a carbon dioxide-insufflated fashion, arterial spasm and reduced early flow may be avoided, even without vasodilator agents such as papaverine.

Carbon Dioxide↗
PubMed2002

The left internal thoracic artery and radial artery composite graft in off-pump coronary artery bypass grafting.

Arterial multivessel bypass grafting without extra corporeal circulation and manipulation of the ascending aorta should be a good surgical option for the treatment of coronary artery disease. An internal thoracic artery (ITA)-radial artery (RA) composite graft was used for this purpose. Between July 2000 and October 2001, we employed the LITA-RA composite graft for off-pump coronary artery bypass in 15 cases. Mean patient age was 71.3 +/- 5.8 years old. Left main trunk disease was present in six patients and triple-vessel disease in four patients. Preoperative concomitant disease was renal dysfunction in three cases, cerebrovascular disease in four and diabetes mellitus in five cases. Two patients had a so-called bad aorta. Twelve elective operations and three urgent operations were carried out for unstable angina. Two to four (mean 2.6 +/- 0.7) anastomoses were performed per patient. Complete revascularization was achieved in 12 out of 15 patients. Mean operating time was 335 +/- 53 min. Mean intraoperative blood loss was 595 +/- 375 ml and nine patients underwent the operation without blood transfusion. There was no PMI, no brain disorder, and no death. Postoperative coronary angiography in all patients documented a good patency rate (LITA 15/15, RA 21/21, right gastroepiploic artery (RGEA) 2/2, and saphenous vein graft (SVG) 0/2). LITA-RA composite grafting in off-pump coronary artery bypass enables arterial multivessel revascularization using an aortic no touch technique. This can be done with minimum postoperative complications and without risk of cerebral infarction even in patients at high risk for extracorporeal circulation (ECC).

Aged↗
PubMed1993

Retrocaval routing of the right internal thoracic artery.

Enhanced use of the right internal thoracic artery affords further opportunity for myocardial revascularization using predominantly arterial conduits. High proximal dissection and routing of the right internal thoracic artery behind the superior vena cava can sometimes allow additional length to the right internal thoracic artery pedicle to facilitate the grafting of posterior and lateral coronary arteries via a less circuitous, more protected route.

Humans↗
PubMed1999

Protective wrapping of the internal thoracic artery.

Injury of a patent internal thoracic artery bypass graft in a patient during cardiac reoperation could have catastrophic results. In selected patients who have primary coronary artery bypass grafting using the internal thoracic artery, we wrap the artery pedicle with an expanded polytetrafluoroethylene membrane to facilitate identification and to protect it during reoperation. No occlusions or other complications related to use of the membrane have occurred.

Coronary Artery Bypass↗