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Wang Z, Liu H, Huan Z, Su C, Chen Y, Wei M. Application of the radial artery after angiography in patients undergoing total arterial coronary revascularization. J Cardiothorac Surg 2024; 19:417. [PMID: 38961485 PMCID: PMC11221012 DOI: 10.1186/s13019-024-02893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/15/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE There is growing evidence supporting the utilization of the radial artery as a secondary arterial graft in coronary artery bypass grafting (CABG) surgery. However, debates continue over the recovery period of the radial artery following angiography. This study aims to evaluate the clinical outcomes and experiences related to the use of the radial artery post-angiography in total arterial coronary revascularization. METHODS A retrospective analysis was performed on data from patients who underwent total arterial CABG surgery at the University of Hong Kong Shenzhen Hospital from July 1, 2020, to September 30, 2022. Preoperative assessments included ultrasound evaluations of radial artery blood flow, diameter, intimal integrity, and the Allen test. Additionally, pathological examinations of the distal radial artery and coronary artery CT angiography were conducted, along with postoperative follow-up to assess the safety and efficacy of using the radial artery in patients undergoing total arterial CABG. RESULTS A total of 117 patients, compromising 102 males and 15 females with an average age of 60.0 ± 10.0 years, underwent total arterial CABG. The internal mammary artery was used in situ in 108 cases, while in 4 cases, it was grafted to the ascending aorta due to length limitations. Bilateral radial arteries were utilized in 88 patients, and bilateral internal mammary arteries in 4 patients. Anastomoses of the proximal radial arteries to the proximal ascending aorta included 42 cases using distal T-anastomosis and 4 using sequential grafts. The interval between bypass surgery and coronary angiography ranged from 7 to 14 days. Pathological examination revealed intact intima and continuous elastic membranes with no significant inflammatory infiltration or hyperplastic lumen stenosis in the radial arteries. There were no hospital deaths, 3 cases of perioperative cerebral infarction, 1 secondary thoracotomy for hemorrhage control, 21 instances of intra-aortic balloon pump (IABP) assistance, and 2 cases of poor wound healing that improved following debridement. CT angiography performed 2 weeks post-surgery showed no internal mammary artery occlusions, but 4 radial artery occlusions were noted. CONCLUSION Ultrasound may be used within 2 weeks post-angiography to assess the recovery of the radial artery in some patients. Radial arteries with intact intima may be considered in conjunction with the internal mammary artery for total arterial coronary CABG. However, long-term outcomes of these grafts require further validation through larger prospective studies.
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Affiliation(s)
- Zanxin Wang
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Haibing Liu
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Zhifu Huan
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Chao Su
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Yao Chen
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China
| | - Minxin Wei
- Department of Cardiac Surgery, The University of Hong Kong-Shenzhen Hospital, Guangdong, P.R. China.
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Emmert MY, Bonatti J, Caliskan E, Gaudino M, Grabenwöger M, Grapow MT, Heinisch PP, Kieser-Prieur T, Kim KB, Kiss A, Mouriquhe F, Mach M, Margariti A, Pepper J, Perrault LP, Podesser BK, Puskas J, Taggart DP, Yadava OP, Winkler B. Consensus statement-graft treatment in cardiovascular bypass graft surgery. Front Cardiovasc Med 2024; 11:1285685. [PMID: 38476377 PMCID: PMC10927966 DOI: 10.3389/fcvm.2024.1285685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024] Open
Abstract
Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. "No-Touch" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.
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Affiliation(s)
- Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Etem Caliskan
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Martin Grabenwöger
- Sigmund Freud Private University, Vienna, Austria
- Department of Cardiovascular Surgery KFL, Vienna Health Network, Vienna, Austria
| | | | - Paul Phillip Heinisch
- German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Teresa Kieser-Prieur
- LIBIN Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Attila Kiss
- Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | | | - Markus Mach
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Adrianna Margariti
- The Wellcome-Wolfson Institute of Experimental Medicine, Belfast, United Kingdom
| | - John Pepper
- Cardiology and Aortic Centre, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - Bruno K. Podesser
- Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, United States
| | - David P. Taggart
- Nuffield Dept Surgical Sciences, Oxford University, Oxford, United Kingdom
| | | | - Bernhard Winkler
- Department of Cardiovascular Surgery KFL, Vienna Health Network, Vienna, Austria
- Ludwig Boltzmann Institute at the Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
- Karld Landsteiner Institute for Cardiovascular Research Clinic Floridsdorf, Vienna, Austria
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3
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Barry M, Gun M, Chabry Y, Harmouche M, Padurean P, Peltier J, Caus T, Havet E. Anatomical and biometric study of the radial artery on human cadavers dissected in the anatomy laboratory. Surg Radiol Anat 2023; 45:1089-1095. [PMID: 37452194 DOI: 10.1007/s00276-023-03190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To study the anatomy and biometry of the radial artery and to report the implications of this study for daily practice in Cardiac Surgery. METHOD Radial arteries from 45 human cadavers (28 males and 17 females, average age 79.2 (92) fixed in 10% formalin were dissected. The proximal and distal internal calibers and lengths of these radial arteries were measured. RESULTS Our results showed the presence of a single radial artery variation in 2.3% of the entire sample (1.1% of the 90 dissected upper limbs). The distance between the epicondyle and the emergence of the radial artery was 32.4 (6.67) mm in men and 30.7 (9.00) mm in women, with an average of 31.8 (7.58) mm. For the right upper limb, the mean proximal internal caliber of the radial artery was 3.16 (0.56) mm and its mean distal internal caliber was 2.62 (0.66) mm. For the left upper limb, the mean proximal internal caliber of the radial artery was 3.17 (0.59) mm and its mean distal internal caliber was 2.64 (0.68) mm. The mean length of the left radial artery was 197.0 (17) mm. The mean length of the right radial artery was 201.0 (33) mm. CONCLUSION It is very important to be aware of the possible anatomical variation of the radial artery. Despite its rarity, this knowledge may ensure a better safety and reliability of the harvesting technique for use as a graft.
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Affiliation(s)
- Misbaou Barry
- Laboratory of Anatomy, Faculty of Medicine, University of Picardie-Jule Vernes, Amiens, France.
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France.
- Heart-Chest-Vascular Surgery, Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France.
| | - Mesut Gun
- Department of Cardiology, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France
| | - Yuthiline Chabry
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France
| | - Majid Harmouche
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France
| | - Paul Padurean
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France
| | - Johann Peltier
- Laboratory of Anatomy, Faculty of Medicine, University of Picardie-Jule Vernes, Amiens, France
| | - Thierry Caus
- Department of Cardiac Surgery, Amiens Picardie University Hospital Center, 1 Rue du Professeur Christian CABROL, 80054, Amiens, Cedex1, France
| | - Eric Havet
- Laboratory of Anatomy, Faculty of Medicine, University of Picardie-Jule Vernes, Amiens, France
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Vervoort D, Elbatarny M, Rocha R, Fremes SE. Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting. J Clin Med 2023; 12:jcm12062275. [PMID: 36983276 PMCID: PMC10056232 DOI: 10.3390/jcm12062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Ischemic heart disease is the leading cause of morbidity and mortality worldwide and may require coronary revascularization when more severe or symptomatic. Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure and can be performed with different bypass conduits and anastomotic techniques. Saphenous vein grafts (SVGs) are the most frequently used conduits for CABG, in addition to the left internal thoracic artery. Outcomes with a single internal thoracic artery and SVGs are favorable, and the long-term patency of SVGs may be improved through novel harvesting techniques, preservation methods, and optimal medical therapy. However, increasing evidence points towards the superiority of arterial grafts, especially in the form of multiple arterial grafting (MAG). Nevertheless, the uptake of MAG remains limited and variable, both as a result of technical complexity and a scarcity of conclusive randomized controlled trial evidence. Here, we present an overview of CABG techniques, harvesting methods, and anastomosis types to achieve total arterial revascularization and adopt MAG. We further narratively summarize the available evidence for MAG versus single arterial grafting to date and highlight remaining gaps and questions that require further study to elucidate the role of MAG in CABG.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Rodolfo Rocha
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Stephen E. Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Correspondence: ; Tel.: +1-416-480-6073
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5
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Vesnina ZV, Grakova EV. Diagnostic radiology methods for assessing coronary artery bypass graft viability. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-140-153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The review describes available modern radiological methods which are currently applied for a detailed and comprehensive anatomical and functional assessment of the viability of various coronary artery bypass grafts. In addition, it presents some aspects of the implementation of these methods and clinical interpretation of the results.
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Affiliation(s)
- Zh. V. Vesnina
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
| | - E. V. Grakova
- Cardiology Research Institute, Tomsk National Research Medical Center (NRMC), Russian Academy of Sciences
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6
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Kasahara H, Shin H, Takahashi T, Murata S, Mori M. Comparison of patency of single and sequential radial artery grafting in coronary artery bypass. Interact Cardiovasc Thorac Surg 2022; 34:515-522. [PMID: 34686883 PMCID: PMC8972210 DOI: 10.1093/icvts/ivab279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Sequential radial artery (RA) grafting has the potential to enhance arterial revascularization compared to single grafting. Sequential RA grafting was performed predominantly with a single side-to-side anastomosis. The study aimed to assess if sequential RA grafting improved long-term graft patency compared to single RA grafting. In addition, the anastomotic patencies of side-to-side and end-to-side anastomoses in sequential RA grafting were assessed. METHODS Two hundred nineteen patients underwent isolated coronary artery bypass grafting with skeletonized RA conduits between 2005 and 2016. Of these, 208 patients underwent radiological graft assessment; thus, 125 and 83 patients underwent single and sequential RA grafting, respectively. The graft and anastomotic patency rates were estimated using the Kaplan-Meier method. RESULTS The median follow-up period was 9.1 years, and the radiological assessment lasted 5.1 years. The overall RA graft patency rates at 1, 5 and 10 years were 99.4%, 92.7% and 88.1%, respectively. The RA graft patency rate for sequential grafting was similar to that for single grafting (88.7% vs 87.4% at 10 years; P = 0.88). In the stratified analysis of anastomotic patency, the patency rate of side-to-side anastomoses of sequential RA grafting was significantly better than that of end-to-side anastomoses (100% vs 88.7% at 10 years; P = 0.01). CONCLUSIONS The long-term RA graft patencies of sequential and single grafting were equally high. The anastomotic patency of side-to-side anastomoses of sequential RA grafting was remarkably high. Considering these findings, the RA can be effectively used for multiple arterial coronary revascularizations.
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Affiliation(s)
- Hirofumi Kasahara
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Hankei Shin
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Tatsuo Takahashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoru Murata
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Mitsuharu Mori
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
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7
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Cancelli G, Audisio K, Chadow D, Soletti GJ, Gaudino M. The evidence for radial artery grafting: When and when not? JTCVS Tech 2021; 10:114-119. [PMID: 34977713 PMCID: PMC8691820 DOI: 10.1016/j.xjtc.2021.09.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | | | | | - Mario Gaudino
- Address for reprints: Mario Gaudino, MD, PhD, Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065.
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Martin AK, Feinman JW, Bhatt HV, Subramani S, Malhotra AK, Townsley MM, Fritz AV, Sharma A, Patel SJ, Zhou EY, Owen RM, Ghofaily LA, Read SN, Teixeira MT, Arora L, Jayaraman AL, Weiner MM, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2021. J Cardiothorac Vasc Anesth 2021; 36:940-951. [PMID: 34801393 DOI: 10.1053/j.jvca.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022]
Abstract
This special article is the fourteenth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the Editor-in-Chief, Dr. Kaplan, and the editorial board for the opportunity to continue this series; namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology. The major themes selected for 2021 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in the specialty for 2021 begin with an update on structural heart disease, with a focus on updates in arrhythmia and aortic valve disorders. The second major theme is an update on coronary artery disease, with discussion of both medical and procedural management. The third major theme is focused on the perioperative management of patients with COVID-19, with the authors highlighting literature discussing the impact of the disease on the right ventricle and thromboembolic events. The fourth and final theme is an update in heart failure, with discussion of diverse aspects of this area. The themes selected for this fourteenth special article are only a few of the diverse advances in the specialty during 2021. These highlights will inform the reader of key updates on a variety of topics, leading to improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Y Zhou
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert M Owen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lourdes Al Ghofaily
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Selina N Read
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Lovkesh Arora
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Arun L Jayaraman
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Rosenfeld ES, Trachiotis GD, Napolitano MA, Sparks AD, Wendt D, Kieser TM, Puskas JD, DiGiammarco G, Taggart DP. Intraoperative transit-time flow measurement and high-frequency ultrasound in coronary artery bypass grafting: impact in off versus on-pump, arterial versus venous grafting and cardiac territory grafted. Eur J Cardiothorac Surg 2021; 61:204-213. [PMID: 34166508 DOI: 10.1093/ejcts/ezab239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/13/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Despite society guideline recommendations, intraoperative high-frequency ultrasound (HFUS) and transit-time flow measurement (TTFM) use in coronary artery bypass grafting (CABG) has not been widely adopted worldwide. This retrospective review of the REQUEST (REgistry for QUality assESsmenT with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery) study assesses the impact of protocolled high-frequency ultrasound/TTFM use in specific technical circumstances of CABG. METHODS Three REQUEST study sub-analyses were examined: (i) For off-pump (OPCAB) versus on-pump (ONCAB) procedures: strategy changes from preoperative plans for the aorta, conduits, coronary targets and graft revisions; and for all REQUEST patients, revision rates in: (ii) arterial versus venous grafts; and (iii) grafts to different cardiac territories. RESULTS Four hundred and two (39.6%) of 1016 patients undergoing elective isolated CABG for multivessel disease underwent OPCAB procedures. Compared to ONCAB, OPCAB patients experienced more strategy changes regarding the aorta [14.7% vs 3.4%; odds ratios (OR) = 4.03; confidence interval (CI) = 2.32-7.20], less regarding conduits (0.2% vs 2.8%; OR = 0.09; CI = 0.01-0.56), with no differences in coronary target changes or graft revisions (4.1% vs 3.5%; OR = 1.19; CI = 0.78-1.81). In all REQUEST patients, revisions were more common for arterial versus venous grafts (4.7% vs 2.4%; OR = 2.05; CI = 1.29-3.37), and inferior versus anterior (5.1% vs 2.9%; OR = 1.77; CI = 1.08-2.89) and lateral (5.1% vs 2.8%; OR = 1.83; CI = 1.04-3.27) territory grafts. CONCLUSIONS High-frequency ultrasound/TTFM use differentially impacts strategy changes and graft revision rates in different technical circumstances of CABG. Notably, patients undergoing OPCAB experienced 4 times more changes related to the ascending aorta than ONCAB patients. These findings may indicate where intraoperative assessment is most usefully applied. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02385344.
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Affiliation(s)
- Ethan S Rosenfeld
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.,Department of Surgery, George Washington University, Washington, DC, USA
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.,Department of Surgery, George Washington University, Washington, DC, USA
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery and Heart Center, Washington DC Veterans Affairs Medical Center, Washington, DC, USA.,Department of Surgery, George Washington University, Washington, DC, USA
| | - Andrew D Sparks
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Teresa M Kieser
- Division of Cardiac Surgery, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke's, New York, NY, USA
| | - Gabriele DiGiammarco
- Department of Cardiac Surgery, Università degli Studi "G. D'Annunzio" Chieti-Pescara, Chieti, Italy
| | - David P Taggart
- Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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10
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Gaudino MFL, Sandner S, Bonalumi G, Lawton JS, Fremes SE. How to build a multi-arterial coronary artery bypass programme: a stepwise approach. Eur J Cardiothorac Surg 2021; 58:1111-1117. [PMID: 33247735 DOI: 10.1093/ejcts/ezaa377] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Observational evidence shows that the use of multiple arterial grafts (MAG) is associated with longer postoperative survival and improved clinical outcomes. The current European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommend the use of MAG in appropriate patients. However, a significant volume-to-outcome relationship exists for MAG, and lack of sufficient experience is associated with increased operative risk. A stepwise approach to building experience with MAG allows successful implementation of this technique into routine coronary surgery practice.
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Affiliation(s)
- Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York - Presbyterian Hospital, New York, NY, USA
| | - Sigrid Sandner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Giorgia Bonalumi
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino-IRCCS, Milan, Italy
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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11
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Moscarelli M, Gaudino M. Calcium-channel blockers in patients with radial artery grafts. When enough is enough. J Card Surg 2021; 36:1827-1831. [PMID: 33728740 DOI: 10.1111/jocs.15411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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12
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Torregrossa G, Amabile A, Williams EE, Fonceva A, Hosseinian L, Balkhy HH. Multi-arterial and total-arterial coronary revascularization: Past, present, and future perspective. J Card Surg 2020; 35:1072-1081. [PMID: 32293059 DOI: 10.1111/jocs.14537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/09/2020] [Accepted: 03/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. METHODS AND RESULTS In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. CONCLUSIONS In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement.
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Affiliation(s)
- Gianluca Torregrossa
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Elbert E Williams
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York City, New York
| | - Ana Fonceva
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Leila Hosseinian
- Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Chicago, Illinois
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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13
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Multiarterial coronary artery bypass grafting: is the radial artery fulfilling the unkept promise of the right internal thoracic artery? Curr Opin Cardiol 2019; 34:628-636. [PMID: 31389824 DOI: 10.1097/hco.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The debate on the second best conduit for CABG is still intense. In this review, we discuss the role of the radial artery and the right internal thoracic artery (RITA) compared with saphenous vein grafts (SVG). RECENT FINDINGS The recent RADIAL STUDY has been the first evidence based on randomized trials of a clinical benefit using a second arterial graft in CABG.On the other hand, the definitive 10-year results of the ART trial failed to show a clinical advantage associated with the use of bilateral internal thoracic artery (BITA). A thorough and contextualized analysis of this and other studies, however, may offer a different perspective. SUMMARY Arterial conduits in CABG have shown better patency rates than SVG. Whether this leads to better clinical outcomes is still debated. In this setting, the radial artery and the RITA seem to offer a similar advantage, although with different indications and contraindications.
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14
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Right internal thoracic or radial artery as the second arterial conduit for coronary artery bypass surgery. Curr Opin Cardiol 2019; 34:564-570. [PMID: 31219879 DOI: 10.1097/hco.0000000000000654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize the available evidence on the use of the right internal thoracic artery (RITA) and the radial artery as the second arterial graft in coronary artery bypass surgery. RECENT FINDINGS The current data support the equipoise of the two conduits in terms of clinical and angiographic outcomes. Both RITA and radial artery have better patency than saphenous vein grafts. The use of the RITA carries an increased risk of deep sternal wound infection (DSWI) if the artery is harvested as pedicle. Bilateral internal thoracic artery grafting is more technically demanding than radial artery use and there is a volume-outcome relationship in terms of mortality and incidence of DSWI. The radial artery is preferable over RITA in right-sided or distal circumflex artery targets with high-degree stenosis and in patients at higher risk for DSWI, whereas it is not recommended to graft vessels with moderate stenosis and in cases of insufficient collateralization from the ulnar artery or previous transradial procedures. SUMMARY The patency rate and clinical outcomes of radial artery and RITA are similar. The use of one or the other should be based on a careful evaluation of the patient's coronary anatomy and comorbidities, the conduit availability and the surgeon's and center's experience.
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15
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Gaudino MFL, Spadaccio C, Taggart DP. State-of-the-Art Coronary Artery Bypass Grafting: Patient Selection, Graft Selection, and Optimizing Outcomes. Interv Cardiol Clin 2019; 8:173-198. [PMID: 30832941 DOI: 10.1016/j.iccl.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Despite the progressive expansion of clinical indications for percutaneous coronary intervention and the increasingly high risk profile of referred patients, coronary artery bypass grafting (CABG) remains the mainstay in multivessel disease, providing good long-term outcomes with low complication rates. Multiple arterial grafting, especially if associated with anaortic techniques, might provide the best longer-term outcomes. A surgical approach individualized to the patients' clinical and anatomic characteristics, and surgeon and team experience, are key to excellent outcomes. Current evidence regarding patient selection, indications, graft selection, and potential strategies to optimize outcomes in patients treated with CABG is summarized.
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Affiliation(s)
- Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10021, USA.
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow G81 4DY, UK; University of Glasgow, Institute of Cardiovascular and Medical Sciences, 126 University Place, Glasgow G128TA, UK
| | - David P Taggart
- Department of Cardiovascular Surgery, University of Oxford, Headley Way, Oxford, Oxforshire OX39DU, UK; Department Cardiac Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, Oxfordshire OX3 9DU, UK
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16
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Tatoulis J. The radial artery in coronary surgery, 2018. Indian J Thorac Cardiovasc Surg 2018; 34:234-244. [PMID: 33060944 DOI: 10.1007/s12055-018-0694-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022] Open
Abstract
It is now 25 years since the radial artery (RA) was reintroduced in coronary surgery. It has evolved into being a significant coronary artery bypass conduit and ranks third in usage after the internal thoracic artery (ITA) and saphenous vein grafts (SVG). Its advantages are that it can be readily and efficiently harvested, is of good length and appropriate size for coronary artery bypass graft (CABG) surgery, is robust and easy to handle, and remains free of atheroma, and there is minimal wound morbidity. The RA must be used judiciously with attention to spasm prophylaxis because of its muscular wall, and by avoiding competitive flow. Its patency is equivalent to the ITAs when placed to similar coronary territories and under similar conditions (stenosis, size, quality) and RA patencies are always superior to those of SVG in both observational and randomized studies-88-90% versus 50-60% at 10 years, and 80-87% versus 25-40% at 20 years. Its use and excellent patencies result in survival results equivalent to bilateral internal thoracic artery (BITA) grafting and always superior to left internal thoracic artery (LITA) +SVG. Typical radial artery multiarterial bypass grafting (RA-MABG) 10-year survivals are 80-90% versus 70-80% for LITA-SVG. In general, for every 100 patients undergoing CABG, 10 more patients will be alive at 10 years post-operatively. The RA also is important in achieving total arterial revascularization, and several reports indicate a further survival advantage for patients having three arterial grafts over two. The RAs are especially useful in diabetic, morbidly obese patients, those with conduit shortage, and leg pathology, and in coronary reoperations. Although the RA has equivalent patencies to the right internal thoracic artery (RITA), it is much more versatile. RAs that have been instrumented by angiography or percutaneous coronary intervention should be avoided. The radial artery has proved to be an excellent arterial conduit, is equivalent to but more versatile than the RITA, and is always superior to SVG. Its use should be part of every coronary surgeon's skill set.
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Affiliation(s)
- James Tatoulis
- Royal Melbourne Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
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17
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Sousa-Uva M, Gaudino M, Schwann T, Acar C, Nappi F, Benedeto U, Ruel M. Radial artery as a conduit for coronary artery bypass grafting: a state-of-the-art primer. Eur J Cardiothorac Surg 2018; 54:971-976. [PMID: 30376067 DOI: 10.1093/ejcts/ezy335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Carnaxide, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Centre, Faculty of Medicine, Porto University, Porto, Portugal
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Thomas Schwann
- Department of Cardiothoracic Surgery, University of Toledo, Toledo, OH, USA
- Department of Cardiothoracic Surgery, University of Massachusetts - Baystate, Springfield, MA, USA
| | - Christophe Acar
- Department of Cardiac Surgery, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Umberto Benedeto
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
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The High Origin of the Radial Artery (Brachioradial Artery): Its Anatomical Variations, Clinical Significance, and Contribution to the Blood Supply of the Hand. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1520929. [PMID: 29992133 PMCID: PMC6016218 DOI: 10.1155/2018/1520929] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/27/2018] [Accepted: 05/20/2018] [Indexed: 12/03/2022]
Abstract
Background This study thoroughly analyzes the anatomic variations of the brachioradial artery (radial artery of high origin) based on the variability of its origin, the presence and types of anastomosis with the brachial artery in the cubital fossa (“cubital crossover” or “cubital connection”), and the pattern of radial recurrent arteries, as well as the vascular territory within the hand. Material and Methods One hundred and twenty randomly selected, isolated upper limbs fixed in 10% formalin solution were dissected. Results The radial artery was found to have a high origin in 9.2% of total number of the limbs: two cases from the axillary artery; nine cases from the brachial artery. Anastomosis between the brachioradial and “normal” brachial arteries in the cubital fossa was also frequently observed (54.6%). The anastomosis (“cubital crossover”) was dominant in one case, balanced in three cases, minimal in two cases, and absent in five cases. Conclusions The brachioradial artery may originate from the brachial and, less frequently, from the axillary artery. Anastomosis between the brachioradial and “normal” brachial arteries in the cubital fossa may be dominant, balanced, minimal, or absent. A complete radioulnar arch was found more often when the brachioradial artery was present as a variant.
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19
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Barry M, Nader J, Hun Y, Havet E, Barry F, Laude M, Bonnaire B, Caus T. [Aberrant birth of a radial artery in the upper third of the forearm: A case report]. Morphologie 2018; 102:101-105. [PMID: 29615313 DOI: 10.1016/j.morpho.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
We report the case of a 68-year-old patient, operated on in our department of a quadruple coronary bypass grafting. The grafting strategy consisted initially on harvesting the left internal thoracic artery and the left radial artery. The harvest of this latter failed because of a rare anatomical variation of the radial artery, which rose from the confluence of two branches: a superficial and a deep radial artery at the proximal third of the forearm approximately 10cm below the elbow.
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Affiliation(s)
- M Barry
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France; Laboratoire d'anatomie, faculté de médecine d'Amiens, université de Picardie Jules-Vernes, 80000Amiens, France.
| | - J Nader
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France
| | - Y Hun
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France
| | - E Havet
- Laboratoire d'anatomie, faculté de médecine d'Amiens, université de Picardie Jules-Vernes, 80000Amiens, France
| | - F Barry
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France
| | - M Laude
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France; Laboratoire d'anatomie, faculté de médecine d'Amiens, université de Picardie Jules-Vernes, 80000Amiens, France; Service d'imagerie et radiologie médicale, CHU Amiens-Picardie, 80080 Amiens, France
| | - B Bonnaire
- Service d'imagerie et radiologie médicale, CHU Amiens-Picardie, 80080 Amiens, France
| | - T Caus
- Service de chirurgie cardiaque, CHU Amiens-Picardie, 80080 Amiens France
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21
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Leonard JR, Abouarab AA, Tam DY, Girardi LN, Gaudino MFL, Fremes SE. The radial artery: Results and technical considerations. J Card Surg 2018; 33:213-218. [DOI: 10.1111/jocs.13533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jeremy R. Leonard
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Ahmed A. Abouarab
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Derrick Y. Tam
- Division of Cardiac Surgery; Schulich Heart Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Mario F. L. Gaudino
- Department of Cardiothoracic Surgery; Weill Cornell Medicine; New York New York
| | - Stephen E. Fremes
- Division of Cardiac Surgery; Schulich Heart Centre; Sunnybrook Health Sciences Centre; University of Toronto; Toronto Ontario Canada
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22
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Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, Di Giammarco G, Fremes S, Glineur D, Grau J, He GW, Marinelli D, Ohmes LB, Patrono C, Puskas J, Tranbaugh R, Girardi LN, Taggart DP, Ruel M, Bakaeen FG. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation 2017; 136:1749-1764. [DOI: 10.1161/circulationaha.117.027597] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Mario Gaudino
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Charalambos Antoniades
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Umberto Benedetto
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Saswata Deb
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Antonino Di Franco
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Gabriele Di Giammarco
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Stephen Fremes
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - David Glineur
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Juan Grau
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Guo-Wei He
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Daniele Marinelli
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Lucas B. Ohmes
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Carlo Patrono
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - John Puskas
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Robert Tranbaugh
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Leonard N. Girardi
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - David P. Taggart
- From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University “G. D’Annunzio,” Chieti, Italy (G.D.G., D.M.); Division of
| | - Marc Ruel
- Division of Cardiac Surgery, School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Canada
| | - Faisal G. Bakaeen
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, and Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX
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Viskovic K, Aslam M. Upper Extremity Medial Arterial Calcification and Peripheral Artery Disease in Asymptomatic Patients With Chronic Kidney Disease in Predialysis Stage. Angiology 2017; 69:406-415. [PMID: 28823179 DOI: 10.1177/0003319717725966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two types of peripheral artery disease (PAD) in asymptomatic patients with chronic kidney disease (CKD) can be detected by the use of duplex Doppler: medial arterial calcification (MAC) and occlusive PAD. The aim of this pilot study is to evaluate different types of subclinical PAD in upper extremities of patients with CKD. The prevalence of upper extremity MAC and occlusive PAD was investigated in 41 asymptomatic patients with CKD and 18 controls with normal kidney function, using duplex Doppler ultrasound, according to the vascular laboratory protocol. A mild-to-severe MAC was significantly more prevalent in patients with CKD compared to the control group ( P = .015), mostly in radial arteries (RAs; P = .002 and P = .016, respectively). The prevalence of occlusive PAD was not significantly different between the 2 groups ( P = .381). Patients in the CKD group were younger, nonsmokers, and more often had hypertension ( P = .038, P = .038, and P = .034, respectively). A duplex ultrasound screening for upper extremity subclinical PAD in patients with CKD in a predialysis stage may identify patients with mild-to-severe MAC which is important in surgery of hemodialysis access.
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Affiliation(s)
- Klaudija Viskovic
- 1 National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Mohammed Aslam
- 2 Department of Surgery, Imperial College, London, United Kingdom
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Samak M, Fatullayev J, Sabashnikov A, Zeriouh M, Schmack B, Ruhparwar A, Karck M, Popov AF, Dohmen PM, Weymann A. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease. Med Sci Monit Basic Res 2016; 22:107-114. [PMID: 27698339 PMCID: PMC5063431 DOI: 10.12659/msmbr.901508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience.
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Affiliation(s)
- Mostafa Samak
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Arjang Ruhparwar
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Heidelberg, Germany
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, London, United Kingdom
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Low origin of the radial artery: a case study including a review of literature and proposal of an embryological explanation. Anat Sci Int 2016; 92:293-298. [PMID: 27631096 PMCID: PMC5315727 DOI: 10.1007/s12565-016-0371-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/05/2016] [Indexed: 11/24/2022]
Abstract
A low origin of the radial artery is a rare anatomical variation, with the incidence estimated at 0.2 %. This report presents a previously unrecorded case of an unusual distal origin of the radial artery, co-occurring with a double recurrent radial artery. The radial artery arose under the pronator teres muscle, 76 mm below the intercondylar line of the humerus. After emerging from under the tendon of the pronator teres muscle, the radial artery took a typical course and terminated in the deep palmar arch. Additionally, the double radial recurrent artery branched directly off the brachial artery, near the level of the radial neck. A well-developed muscular branch of the first radial recurrent artery ran beneath the brachioradialis muscle and supplied the brachioradialis, extensor carpi radialis longus and brevis, as well as supinator muscles. The second (accessory) radial recurrent artery took origin from the posterior aspect of the brachial artery, ran deep to the distal tendon of the biceps brachii muscle and terminated by joining the articular network of elbow. According to recent theories, the plexiform appearance of the arteries at early stages of upper limb development allows for formation of alternative pathways of blood flow, which may give rise to variations in the definitive arterial pattern.
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Abstract
Coronary artery bypass grafting is the most common cardiac surgery operation performed worldwide. It is the most effective revascularization method for several categories of patients affected by coronary artery disease. Although coronary artery bypass grafting has been performed for more than 40 years, no detailed guidelines on the choice of coronary artery bypass grafting conduits have been published and the choice of the revascularization strategy remains more a matter of art than of science. Moreover, there is a clear contradiction between the proven benefits of arterial grafting and its very limited use in everyday clinical practice. In the hope of encouraging wider diffusion of arterial revascularization and to provide a guide for clinicians, we discuss current evidence for the use of different conduits in coronary artery bypass surgery and propose an evidence-based algorithm for the choice of the second conduit during coronary artery bypass operations.
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