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At least 19 recordsLinked to original sources
PubMed2005

Has the in situ right internal thoracic artery been overlooked? An angiographic study of the radial artery, internal thoracic arteries and saphenous vein graft patencies in symptomatic patients.

OBJECTIVE: The right internal thoracic artery is being used infrequently despite favorable observational angiographic data. Conversely, the radial artery utilization has increased with only limited data available. The purpose of this paper is to re-evaluate the roles of the right internal thoracic artery and the radial artery grafts. METHODS: We reviewed all ischemia-directed coronary angiographic procedures from January 1996 to December 2003. A total of 219 patients had primary coronary artery bypass grafting with an internal thoracic artery and a radial artery as two of the bypass grafts. Six hundred and seventy-nine (679) graft angiograms (45 saphenous vein, 363 radial artery, 54 right internal thoracic artery and 217 left internal thoracic artery) were studied. The mean period from operation to re-angiogram was 1104+/-761 days. Angiographic outcomes were divided into groups as: (1) patent (<50% stenosis) or (2) failed (>or=50% stenosis, string sign or occluded). A generalized linear mixed model was used to analyze predictors of graft patency. Turnbull's estimates of cumulative patency were used to compare graft failure rates over time. RESULTS: A total of 632/679 (93%) grafts were patent and 47/679 (7%) grafts had failed. Empirical saphenous vein graft patency was 40/45 (89%), radial artery patency 329/363 (91%), right internal thoracic artery patency 51/54 (94%) and left internal thoracic artery patency 212/217 (98%). Pairwise comparisons of patency from the generalized linear mixed model were: LITA>RITA, OR=1.5 (P=0.5); LITA>RA, OR=5.7 (P<0.001); LITA>SV, OR=6.5 (P<0.001); RITA>RA, OR=3.9 (P=0.01); RITA>SV, OR=4.4 (P=0.01); RA>SV, OR=1.1 (P=0.7). Five-year patency estimates from the Turnbull's model were the left internal thoracic artery (95.9%), right internal thoracic artery (91.2%), the radial artery (90.6%) and the saphenous vein (81.8%). CONCLUSIONS: Consideration should be given to the routine use of both internal thoracic arteries for coronary artery bypass grafting. When additional grafts are required, there is no evidence to suggest that either the radial artery or saphenous vein is superior.

Aged↗
PubMed1999

T grafts with the right internal thoracic artery to left internal thoracic artery versus the left internal thoracic artery and radial artery: flow dynamics in the internal thoracic artery main stem.

OBJECTIVE: Complete arterial coronary artery bypass grafting with 2 grafts can be achieved even in triple vessel disease by use of a T configuration. There is still uncertainty whether the coronary flow reserve in the main stem of the left internal thoracic artery is sufficient to supply more than 1 anastomosed coronary vessel. METHODS: Between March 1996 and February 1999, 251 patients with multivessel coronary artery disease underwent complete arterial revascularization with T grafts, using either the left internal thoracic artery with the free right internal thoracic artery graft (n = 73, group I) or the left internal thoracic artery and radial artery (n = 178, group II). A mean of 4.0 (group I) versus 4.3 (group II) coronary vessels were anastomosed per patient. One week (n = 92) and 6 months (n = 28) after the operation, flow was measured in the proximal left internal thoracic artery with a Doppler guide wire. Maximum flow was determined after injection of adenosine (30 microg). RESULTS: The in-hospital mortality was 2.7% (group I) versus 2.3% (group II). At angiography (n = 142, 56.6%) the patency rate was 96.3% (group I) versus 98.2% (group II). There was no significant difference between baseline flow, maximum flow, and coronary flow reserve between the 2 groups. Coronary flow reserve increased in both groups within the first 6 postoperative months (group I, 1.85 +/- 0.31 vs 2.77 +/- 0.77, P =.0002; group II, 1.82 +/- 0.4 vs 2.53 +/- 0.73, P =.009). CONCLUSION: Both variants of T grafts allow for complete arterial revascularization with good perioperative results. The flow reserve of the proximal internal thoracic artery is adequate for multiple coronary anastomoses irrespective of the choice of the second arterial graft.

Blood Flow Velocity↗
PubMed2001

End of the millenium--end of the single thoracic artery graft? Two thoracic arteries--standard for the next millenium? Early clinical results and analysis of risk factors in 1,487 patients with bilateral internal thoracic artery grafts.

PURPOSE: CABG with bilateral IMA grafts (BIMA) can improve long-term results in cardiac morbidity and mortality. An enhanced incidence of bleeding and wound complications compared to patients with single IMA (SIMA) remains a matter of debate. The aim of the study was to compare the operative outcomes of patients who had undergone CABG with BIMA and SIMA in situ grafts, especially to identify patient-related risk factors, such as obesity, diabetes mellitus and age above 70 years. METHODS: Out of a total of 5,144 patients operated on between January 1996 and September 1999, patients with isolated CABG (n = 3,671) with BIMA or SIMA were analyzed retrospectively. In the BIMA group, the patients' (n = 1,487) mean age was 64.0 years; mean EF was 62.1%. In the SIMA group (n = 2,184), the mean age was 65.4 years and mean EF 60.6% (n. s.). In the BIMA group, the right IMA was anterior of the aorta to the LAD, the left IMA to the lateral wall. In the SIMA group, the LAD was revascularisized with the left IMA. Additional bypasses were performed with vein grafts. RESULTS: The 30-day lethality was 1.6% in the BIMA group, 1.7% in the SIMA group in patients under 70, and 4.1% (BIMA) and 4.0% (SIMA) in patients over 70 (p = n.s.). A significantly higher blood loss was observed in the BIMA group (BIMA 979+/-708 ml, SIMA 790+/-575 ml, p<0.05). The rethoracotomy rate due to bleeding was significantly higher in patients with BIMA (4.1%) compared to those with SIMA (2.5%, p<0.05). In patients with a body mass index (BMI) of less than 27, no significant difference could be found (SIMA 2.8%, BIMA 3.4%, p = n. s.). Patients with a BMI >27 showed a significantly higher rethoracotomy rate (SIMA 2.2%, BIMA 4.9%). A higher incidence of sternal instabilities could be observed in the BIMA group (4.2%, p<0.05). Diabetes mellitus could not be identified as an independent risk factor for sternal complications (SIMA 2.9%, BIMA 5.0%, p = n. s.). COUCLUSION: CABG using both IMA's can be performed in nearly all patients as a routine method with good clinical results and low mortality. Bleeding in the BIMA group within 48 hours was increased. BMI >27 could be identified as a risk factor for sternal complications, but not diabetes mellitus or age over 70 years.

Age Factors↗
PubMed1991

[Multiple coronary aneurysms due to Kawasaki disease in young man--successful triple coronary bypass grafting by utilizing the right gastroepiploic artery, internal thoracic artery and saphenous vein].

A 28-year-old man developed acute anteroseptal myocardial infarction. Emergency coronary angiography revealed multiple coronary aneurysms, associated with complete obstruction of left anterior descending artery (LAD) and 50 to 99% stenosis of the right and the circumflex coronary artery (CX). Coronary artery bypass graftings were performed seven weeks after successful emergency intracoronary thrombolysis. The saphenous vein graft was anastomosed to CX, the internal thoracic artery to LAD, the right gastroepiploic artery to RCA just above the bifurcation. Post-operative course was uneventful. On sixth post operative week cardiac catheterization was performed. The study showed all three bypass grafts and native coronary artery to be patent. The patient is now followed up under anticoagulant therapy.

Adult↗
PubMed2000

Expression and function of angiotensin converting enzyme, chymase, and angiotensin II in the human radial artery and internal thoracic artery.

BACKGROUND: The potential role of the local renin-angiotensin system to differentially affect radial artery and internal thoracic artery graft performance has not been examined. METHODS: Contractile responses to angiotensin I and II in the radial artery and the internal thoracic artery were examined in vitro. The expression function, and localization of angiotensin receptors, angiotensin converting enzyme, and chymase were studied in radial artery and internal thoracic artery segments. RESULTS: Angiotensin I and II contractions were significantly greater (p < 0.05) in the radial artery compared to the internal thoracic artery. In both arteries, angiotensin II responses were mediated via the AT1 receptor. Messenger RNA transcripts for angiotensin-converting enzyme and chymase were detected in both arteries. Angiotensin-converting enzyme was localized to luminal and vaso vasorum endothelial cells and smooth muscle cells in both vessels, while chymase was colocalized with mast cells in adventitial and medial layers. An angiotensin converting enzyme or a chymase inhibitor singularly had no effect on angiotensin I contractions, however, when combined, a marked inhibition of the angiotensin I response was observed in both vessels. CONCLUSIONS: Our results illustrate the complexities which exist within the local renin angiotensin system and suggest that clinical trials which may modulate the system are warranted.

Aged↗
PubMed1998

[Failure of coronary artery bypass with the internal thoracic artery. Does extended use of the internal thoracic artery affect the patency of the coronary artery?].

OBJECTIVE: The aim of this study was to precise the circumstances of the failure of coronary artery bypass graft by internal thoracic artery (ITA). METHODS: It was a retrospective study which compared angiographic results between several techniques of ITA graft; 512 coronary artery bypass graft have been realized on 302 patients: 115 single left ITA grafts, 78 sequential left ITA grafts, 48 bilateral pedicled ITA grafts, 61 bilateral ITA Y grafts. The mean interval between operation and reangiography was 17.3 months (s = 4.1 months). Graft failures were occluded and non functioning ITA grafts (threadlike ITA). RESULTS: There were 11 occluded grafts (2%) and 19 non functionning grafts (4%). There was no difference of failure rate between the 4 techniques of ITA grafts (p > 0.05). The failure rate for right ITA grafts 13% was higher than for the left ITA grafts 4% (p < 0.001). The failure rate for obtuse marginal branch grafts 13% was higher than for left anterior descending artery grafts 3% (p < 0.001). CONCLUSION: The extended use of ITA doesn't increase the risk of graft failure rate. The patency of obtuse marginal branch ITA graft is less than the patency of left anterior descending artery or diagonal branch ITA grafts.

Coronary Angiography↗
PubMed2002

[Redo coronary artery bypass grafting using the patent left internal thoracic artery graft as an in flow with composite internal thoracic artery Y grafting; report of a case].

In redo coronary artery bypass grafting (CABG), graft selection and revascularization methods are major problems. We experienced a redo-CABG with occluded previous vein grafts. These grafts were to the circumflex artery and right coronary artery. We conducted operation using cardiopulmonary bypass. We at this operation, chose right internal thoracic artery (RITA) as a conduit and anastomosed it to the side of functioning left internal thoracic artery (LITA) graft, and then diogonal branch, posterolateral branch, and atrioventricular branch were revascularized with the RITA. Post operative course was uneventful. Internal thoracic artery (ITA) is superior to vein graft and other arterial graft as to long term patency. We believe composite Y graft with the use of bilateral ITA can be one of the revascularization strategy in redo CABG.

Coronary Artery Bypass↗
PubMed2006

Does use of a right internal thoracic artery increase deep wound infection and risk after previous use of a left internal thoracic artery?

OBJECTIVE: To determine whether adding right internal thoracic artery to previous left internal thoracic artery bypass at reoperation increases deep sternal wound infection and hospital mortality, particularly in diabetic patients. METHODS: Reoperations (n = 2875; 2381 men) in patients with previous left internal thoracic artery bypass were performed between January 1990 and January 2003; 1939 (67%) had no repeat internal thoracic artery grafting, 923 (32%) received an additional right internal thoracic artery graft, and 13 (0.5%) had bilateral internal thoracic artery grafting with reuse of the left internal thoracic artery. Of the patients, 352 (12%) were insulin-treated and 590 (21%) non-insulin-treated diabetics. Multivariable logistic regression analysis was used to identify preoperative variables associated with right versus non-right internal thoracic artery use in diabetics and nondiabetics and to formulate propensity models. Propensity scores were used for matching and adjusted multivariable analyses of deep wound infection and hospital mortality. RESULTS: Deep wound infection occurred in 3.0% (7/230) of diabetics receiving right internal thoracic artery grafts, 2.2% (5/230) of propensity-matched diabetics receiving non-right internal thoracic artery grafts (P = .6), in 1.1% (6/538) of nondiabetics receiving right internal thoracic artery grafts, and in 1.0% (5/538) of matched non-diabetic patients receiving non-right internal thoracic artery grafts (P = .8). Corresponding hospital mortality in these matched groups was 1.7% (4/230) versus 6.1% (14/230) for diabetics (P = .02) and 2.6% (14/538) versus 3.5% (19/538) for nondiabetics (P = .4). Risk factors for deep wound infection included higher weight (P = .0003), higher New York Heart Association functional class (P = .03), and less severe left anterior descending disease (P = .03). Risk factors for death were (P < .02) emergency operation, mitral valve replacement, and greater number of saphenous vein grafts. CONCLUSIONS: Use of the right internal thoracic artery for reoperations does not increase the risk of deep wound infections in diabetics or nondiabetics and does not increase mortality.

Aged↗
PubMed2002

Revascularization of the lateral wall: long-term angiographic and clinical results of radial artery versus right internal thoracic artery grafting.

OBJECTIVE: We sought to evaluate whether the radial artery provides the same results as the right internal thoracic artery in lateral wall revascularization in the long term. METHODS: From January 1992 to September 1996, 288 patients had myocardial revascularization with the left internal thoracic artery anastomosed to the left anterior descending coronary artery. The lateral wall was grafted with the radial artery in 139 patients (group A) and with the right internal thoracic artery in 149 patients (group B). Groups were different only because of older age and a higher incidence of patients requiring urgent treatment in group A. Y grafting was used in 86.4% of patients in group A and in 34.8% of patients in group B (P < .001). Anastomoses per patient were similar in both groups (3.2 +/- 0.8 vs 3.2 +/- 0.9, P = 1.000). RESULTS: Thirty-day mortality was similar (2.1% vs 2.0%, P = .722). There were 15 late deaths in group A versus 11 in group B (P = .418). Cause of death was cardiac related in 6 patients in group A versus 7 in group B. Late redo or percutaneous transluminal coronary angioplasty was performed in 3 patients in group A and in 1 patient in group B (P = 0.538). Eight-year survival was 86.7% +/- 2.9% in group A versus 89.6% +/- 2.8% in group B (P = .477); event-free survival was 84.2% +/- 3.2% versus 88.9% +/- 2.9%, respectively (P = .430). The patency rate within 30 days was 99.1% in group A (105/106 left internal thoracic artery plus radial artery anastomoses) versus 100% in group B (52/52 bilateral internal thoracic artery anastomoses; P = .715). After a mean of 35 +/- 28 months, the patency rate was 99.0% in group A (100/101 left internal thoracic artery plus radial artery anastomoses) and 100% in group B (33/33 bilateral internal thoracic artery anastomoses, P = .560). CONCLUSION: In the long-term, lateral wall grafting with the radial artery provides the same clinical and angiographic results as right internal thoracic artery grafting.

Coronary Angiography↗
PubMed2002

Complete arterial coronary revascularisation using radial artery conduit for double thoracic artery inlet flow: arterial sling operation.

BACKGROUND: Coronary artery bypass graft surgery with arterial revascularisation of all diseased coronary vessels is considered highly efficient because arterial grafts have an excellent long-term patency compared with venous grafts. However, problems to reach the infero-lateral wall with the in situ internal thoracic arteries usually require alternative techniques. We present the first results of a new surgical principle using a free radial artery segment to complete the arterial coronary revascularisation and concomitantly connect the internal thoracic arteries. METHODS: In patients referred for coronary bypass surgery and three-vessel disease an end-to-end anastomosis of the right internal thoracic artery and the radial artery segment preceded cardiopulmonary bypass, during which side-to-side anastomoses of the radial artery segment were used to revascularise stenotic branches of the right coronary and circumflex arteries. The left internal thoracic artery was used for revascularisation of stenotic branches of the left anterior descending artery, and finally an end-to-side anastomosis of the radial artery segment to the left internal thoracic artery was performed. Coronary artery blood flow was measured in 41 patients with Doppler flow probe. RESULTS: One hundred and ninety-two coronary anastomoses (an average of 4.2 per patient) were performed in 46 patients. We measured a mean total blood flow in the arterial sling graft of 104ml/min (range 35-221ml/min), compared with 69 and 68ml/min of the single inlet right and left internal thoracic arteries, respectively (P<0.01). Flow capacities of 104 and 120ml/min of the right and left internal thoracic arteries were measured during clamp of both the aorta and the contralateral internal thoracic artery. The mean crossclamp duration was 77min (range 51-113min). Postoperative angiography demonstrated patent graft anastomoses to all coronary arteries. There were no perioperative deaths or myocardial infarctions. One patient had a minor postoperative stroke. DISCUSSION: Complete arterial revascularisation can be achieved by the arterial sling operation with an acceptable crossclamp time and a high early rate of graft patency. The double arterial inlet provides a 50% higher blood flow to the beating heart and two-fold increase in the flow reserve compared with a single inlet. Although further research including long-term follow-up of this new principle is required, the present findings seem promising and suggest that the arterial sling operation has a potential role for complete arterial coronary revascularisation.

Coronary Circulation↗
PubMed1999

Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis.

BACKGROUND: In this study, we examined the comparative histopathology, morphometry, and risk factors for the development of intimal hyperplasia and atherosclerosis in the radial artery (RA) and the internal thoracic artery (ITA). METHODS AND RESULTS: Paired specimens of RAs and ITAs, obtained from 150 patients who underwent CABG, were evaluated with histopathology; 110 pairs of arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio. Risk factors were determined with stepwise linear regression. Intimal hyperplasia was seen in 141 RAs (94%) and 103 ITAs (69%) (P<0.001). Atherosclerosis was seen in 5% of RAs and 0.7% of ITAs (P=0.04). Medial calcification was found only in RAs (20 of 150, 13.3%) (P<0.001). Morphometric analysis showed that compared with ITAs, RAs had a significantly higher intimal area, medial area, percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio (all P<0.001) Factors found to be significant (P<0.05) predictors of the 3 severity indices of intimal hyperplasia, including atherosclerosis, in RAs were peripheral vascular disease, smoking, age, and diabetes. Risk factors for intimal hyperplasia in ITAs were age and smoking. CONCLUSIONS: The RA is more likely to have atherosclerosis, intimal hyperplasia, and medial calcification than the ITA. Morphometric analysis indices showed marked differences between the RA and the ITA. Care should be taken when selecting the RA as a conduit in CABG, particularly in patients who are elderly, diabetic, smoke, or have peripheral vascular disease.

Adult↗
PubMed1998

Internal thoracic artery malperfusion syndrome after bilateral internal thoracic artery grafting: report of a case.

A 58-year-old man with postinfarction unstable angina was referred to the Department of Cardiovascular Surgery at the Saiseikai Kitakami Hospital for urgent coronary revascularization. The bilateral internal thoracic arteries (ITAs) were subsequently utilized to revascularize the myocardium. The left anterior descending artery (LAD) was revascularized with the in situ right ITA and the obtuse marginal artery was revascularized with the in situ left ITA. Although he was successfully weaned from cardiopulmonary bypass, he collapsed hemodynamically 15 min later. Thus, he underwent supplementary vein bypass grafting to the distal LAD and the diagonal artery. Postoperatively, his course was uneventful, apart from the perioperative infarction, and a coronary arteriogram demonstrated patent bilateral ITAs and vein graft. This case report emphasizes the importance of early recognition of this rare syndrome and advocates surgical treatment consisting of supplementary vein grafting.

Coronary Disease↗
PubMed2005

Greater vasopressin-induced vasoconstriction and inferior effects of nitrovasodilators and milrinone in the radial artery than in the internal thoracic artery.

BACKGROUND: Vasopressin may be a potential cause of spasm in both the radial artery and the internal thoracic artery. This study compared the vasopressin-induced contraction and the effects of milrinone, nitroglycerin, and nitroprusside in vasopressin-induced contraction between the human radial artery and the internal thoracic artery to find effective antispastic methods for arterial grafts. METHODS: Concentration-contraction (normalized as force gram produced by each millimeter of the circumference tissue of the artery) curves for vasopressin with or without pretreatment of vasodilators and concentration-relaxation curves for the vasodilators listed were established in the human radial artery (n = 107) and internal thoracic artery (n = 122) segments. RESULTS: Vasopressin induced a greater contraction in the radial artery than in the internal thoracic artery (1.9 +/- 0.2 g/mm vs 0.6 +/- 0.1 g/mm, P < .001) with a higher sensitivity (lower EC(50): -9.28 +/- 0.11 vs -8.91 +/- 0.05 log(10)M, P = .006). Milrinone was less potent than nitroglycerin and nitroprusside with higher EC(50) (P < .05) in both the internal thoracic artery and radial artery. Pretreatment with milrinone and nitroprusside significantly inhibited vasopressin contraction in the internal thoracic artery but had little effect in the radial artery. Pretreatment with nitroglycerin did not significantly inhibit the maximum vasopressin contraction in either the internal thoracic artery or radial artery. CONCLUSION: The radial artery is more prone to develop spasm related to vasopressin than is the internal thoracic artery, and the effect of vasodilators in vasopressin-induced contraction is different in the radial artery from that in the internal thoracic artery. A more significant prophylactic antispastic effect of milrinone and nitroprusside is demonstrated in the internal thoracic artery than in the radial artery. Therefore, more intensive antispastic treatment is necessary in the radial artery than in the internal thoracic artery during coronary artery bypass grafting.

Analysis of Variance↗
PubMed1995

Complete arterial myocardial revascularization using the right gastroepiploic artery and both internal thoracic arteries as pedicled grafts.

To achieve complete arterial myocardial revascularization without vein grafts, the right gastroepiploic artery and both internal thoracic arteries were used as pedicled grafts in 105 patients from March 1989 to July 1994. There were 101 male and 4 female patients, with a mean age of 51 years (range 32 to 65 years). Three-vessels disease was present in all patients. Six patients underwent previous bypass procedures with the use of vein grafts. A total of 363 distal anastomosis (108 with the right gastroepiploic artery, 255 with both internal thoracic arteries) were constructed. The mean number of distal anastomoses was 3.4. There was no hospital mortality. Seven patients required a rethoracotomy: 5 because of post-operative signs of ischemia, 2 because of bleeding. In one patient a splenectomy had to be performed because of bleeding. A new Q wave was noted in 2 patients. Follow-up averaged 21 months (range 1 to 67 months). Ninety nine (95%) of the patients were in NYHA class I, 6 (5%) in class II. No late complications were noted. We conclude that, complete myocardial revascularization using the right gastroepiploic artery in combination with both internal thoracic arteries as pedicled grafts can be achieved in selected patients with excellent mid term results.

Adult↗
PubMed1997

Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries.

OBJECTIVE: We prospectively tested the feasibility of achieving total arterial revascularization with the use of the radial artery to revascularize the circumflex, diagonal, and right coronary arteries combined with a left internal thoracic artery graft to the left anterior descending artery and, in some cases, a right internal thoracic artery graft to the right coronary artery. METHODS: In 164 patients, the radial artery was used as a free Y or T graft from the left internal thoracic artery. Of 568 grafts (3.5 +/- 1 [standard deviation] per patient), 296 (1.8 +/- 0.8 per patient) were constructed with the radial artery as single grafts or as double, triple, or quadruple sequential anastomoses to the circumflex, diagonal, and posterior descending arteries. Diltiazem was administered to prevent spasm. Forty-six patients underwent coronary angiography before discharge from the hospital. Follow-up time was 1 to 19 (9.5 +/- 6.1) months. RESULTS: Total arterial revascularization was achieved in 137 patients (83.5%). Three (1.8%) died postoperatively of sepsis, ventricular fibrillation, and heart failure, respectively. Three (1.8%) had postoperative myocardial infarction. No hand ischemia occurred. Angiography showed patency of all arterial conduits. Radial artery spasm appeared in 3 (6.5%) of 46 angiograms. Two patients (1.2%) died during the follow-up period of pneumonia and gastrointestinal tract bleeding, respectively. No other events or reoperations occurred, and 95.1% of the patients are free of symptoms. CONCLUSIONS: The radial artery, as a free Y or T graft from the left internal thoracic artery to the circumflex, diagonal, and right coronary arteries, permits total arterial revascularization with excellent patency rates, minimal morbidity and mortality, and no need for reoperation. Longer follow-up times are necessary to draw definitive conclusions.

Coronary Angiography↗
PubMed1995

Reimplantation of the right internal thoracic artery as a free graft into the left in situ internal thoracic artery (Y procedure). One-year angiographic results.

Reimplantation of the right internal thoracic artery, as a free graft, into the left in situ internal thoracic artery (Y procedure) has enabled us to bypass more distant marginal vessels, which was not possible by the bilateral technique alone. This prospective study was aimed at evaluating the clinical state of the patients and the degree of patency of grafts within 16 months of follow-up. All 80 patients who underwent the Y procedure between January 1988 and January 1992 were included. This group represented 10% of the 840 patients having coronary bypass during the same period. A total of 202 coronary anastomoses were performed in this series. Early postoperative (30 days) complications included three deaths (3.75%), eight myocardial infarctions (10%), one case of phrenic nerve paralysis (1.25%), two cases of respiratory failure (2.5%), and six wound infections (7.5%). At 3 months' follow-up, 96% of patients were free of symptoms. During the follow-up period, four patients died of noncardiac causes (lung, pancreatic, and brain cancer and rupture of an abdominal aortic aneurysm). At 1 year, 71 patients were free of symptoms (97%). Sixty-one patients underwent coronary angiography between 12 and 24 months. Six patients with peripheral arterial disease were not suitable for coronary angiography, and six refused to be tested. These 12 patients had normal thallium test results in the bypassed area (stress or dipyridamole test). The patency rate of the left internal thoracic artery was 98.3% (n = 60), occlusion rate 1.6% (n = 1), and incidence of threadlike arteries 4.9% (n = 3). Thus the rate of perfect patency was 93.4%. The patency rate of the right internal thoracic artery as a free graft was 93.4% (n = 57), occlusion rate 6.5% (n = 4), and the incidence of threadlike arteries 8% (n = 5). Thus the rate of perfect patency was 85.2%. A total of 169 anastomoses were studied. The rate of patency of the anastomoses to the left anterior descending coronary artery was 96% (n = 58) and the occlusion rate, 4% (n = 2). The patency rate of sequential anastomoses (side to side) to diagonal arteries was 100% (n = 16). Patency rate of anastomoses to obtuse marginal arteries was 95% (n = 58) and the rate of occlusion, 4.9% (n = 3). The patency rate of anastomoses to the posterior descending artery or distal branches of the right coronary artery was 80% (n = 4/5).(ABSTRACT TRUNCATED AT 400 WORDS)

Anastomosis, Surgical↗
PubMed2001

Effect of coronary artery bypass grafting on native coronary artery stenosis. Comparison of internal thoracic artery and saphenous vein grafts.

BACKGROUND: The purpose of this study was to investigate the influence of coronary artery bypass grafting on the degree of stenosis of the native coronary artery. METHODS EXPERIMENTAL DESIGN: retrospective data analysis. SETTING: University hospital. PATIENTS: consecutive patients undergoing coronary artery bypass grafting (n=52). Bypasses using internal thoracic artery grafts (n=26) and saphenous vein grafts (n=37) to incompletely occluded coronary arteries were studied. INTERVENTIONS: coronary artery bypass grafting using internal thoracic artery or saphenous vein grafts. MEASURES: stenosis of the native coronary artery on angiography. RESULTS: Three recipient coronary arteries bypassed with internal thoracic artery grafts (12%) and 14 recipient coronary arteries bypassed with saphenous vein grafts (38%) showed progression of narrowing (p=0.024). Two recipient coronary arteries bypassed with internal thoracic artery grafts (8%) and 13 recipient coronary arteries bypassed with saphenous vein grafts (35%) showed total occlusion (p=0.016). Hypertension, hyperlipidemia, diabetes mellitus, and smoking history did not correlate with progression of stenosis of the native coronary arteries. Graft flow measured during surgery in the saphenous vein grafts was not significantly different between the group that exhibited progression of the native stenosis and the group that did not. CONCLUSIONS: Coronary artery bypass grafting with saphenous vein grafts may result in progression of stenosis of the recipient coronary artery. This is less likely after coronary artery bypass grafting with internal thoracic artery grafts. This difference may be due to the ability of the pedicled internal thoracic artery graft to regulate flow. Thus competitive flow in the native coronary artery is minimized. This has significant clinical implications.

Aged↗