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Knochenhauer T, Schaefer A, Brickwedel J, Reiter B, Naito S, Zipfel S, Schneeberger Y, Reichenspurner H, Sill B. Association of HbA1c and utilization of internal mammary arteries with wound infections in CABG. Front Cardiovasc Med 2024; 11:1345726. [PMID: 38562186 PMCID: PMC10982407 DOI: 10.3389/fcvm.2024.1345726] [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: 11/28/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Deep sternal wound infection (DSWI) remains a serious complication after coronary artery bypass grafting (CABG). We herein aimed to stratify diabetic patients who underwent CABG using bilateral internal mammary artery (BIMA) for levels of glycated hemoglobin A1C (HbA1c) and compare postoperative outcomes. Methods Between January 2010 and August 2020, 4,186 consecutive patients underwent isolated CABG at our center. In 3,229 patients, preoperative HbA1c levels were available. Primary endpoints were wound healing disorder (WHD), DSWI, and 30-day mortality. Patients were stratified according to preoperative HbA1c levels. Patients were further divided into subgroups according to utilization of BIMA. Results After adjustment, no differences in mortality and stroke rates were seen between group 1 (HbA1c < 6.5%) vs. group 2 (HbA1c ≥ 6.5%). WHD was more frequent in group 2 [2.8 vs. 5.6%; adjusted p = 0.002; adjusted odds ratio (OR), 1.853 (1.243-2.711)] but not DSWI [1.0 vs. 1.5%; adjusted p = 0.543; adjusted OR, 1.247 (0.612-2.5409)]. BIMA use showed a higher rate of WHD [no BIMA: 3.0%; BIMA: 7.7%; adjusted p = 0.002; adjusted OR, 4.766 (1.747-13.002)] but not DSWI [no BIMA: 1.1%; BIMA: 1.8%; adjusted p = 0.615; adjusted OR, 1.591 (0.260-9.749)] in patients with HbA1c ≥ 6.5%. Conclusions Intraoperative utilization of BIMA is not connected with an increase of DSWI but higher rates of WHD in patients with poor diabetic status and HbA1c ≥ 6.5%. Therefore, application of BIMA should be taken into consideration even in patients with poor diabetic status, while identification of special subsets of patients who are at particular high risk for DSWI is of paramount importance to prevent this serious complication.
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Masroor M, Zhou K, Chen C, Fu X, Zhao Y. All we need to know about internal thoracic artery harvesting and preparation for myocardial revascularization: a systematic review. J Cardiothorac Surg 2021; 16:354. [PMID: 34961523 PMCID: PMC8711206 DOI: 10.1186/s13019-021-01733-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022] Open
Abstract
Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.
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Affiliation(s)
- Matiullah Masroor
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China.,Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd, Afshar, Kabul, Afghanistan
| | - Kang Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Xianming Fu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Yuan Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China.
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Mazur P, Litwinowicz R, Tchantchaleishvili V, Natorska J, Ząbczyk M, Bochenek M, Przybylski R, Iwaniec T, Kȩdziora A, Filip G, Kapelak B. Left Internal Mammary Artery Skeletonization Reduces Bleeding—A Randomized Controlled Trial. Ann Thorac Surg 2021; 112:794-801. [DOI: 10.1016/j.athoracsur.2020.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/03/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
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4
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Elsherif SB, Sharma S, Green K, Fischer A, Ozdemir S, Wynn G. Recurrent Metastatic Breast Cancer in Internal Mammary Lymph Nodes along the Translocated Left Internal Mammary Artery Bypass Graft. Radiol Cardiothorac Imaging 2021; 3:e210042. [PMID: 34235448 DOI: 10.1148/ryct.2021210042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 11/11/2022]
Abstract
Internal mammary lymph node (IMLN) is the second most common site for nodal metastases in breast cancer. The authors present a case of a 58-year-old woman with a history of coronary artery bypass graft surgery 1 year prior who presented with a neck mass. Imaging showed an enlarged IMLN along the course of the translocated left internal mammary artery (LIMA) bypass graft on the surface of the heart, and the patient was later proven to have recurrent breast cancer. To the authors' knowledge, this is the first case report in the literature of a breast cancer recurrence in an IMLN along the postoperative translocated LIMA bypass graft. Keywords: Adults, CT, PET/CT, Breast, Thorax, Lymphatic, Metastases © RSNA, 2021.
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Affiliation(s)
- Sherif B Elsherif
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
| | - Swati Sharma
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
| | - Kevin Green
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
| | - Austin Fischer
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
| | - Savas Ozdemir
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
| | - Gregory Wynn
- Department of Radiology (S.B.E., S.S., A.F., S.O., G.W.) and Division of Pulmonary and Critical Care Medicine (K.G.), University of Florida College of Medicine, 655 W 8th St, 2nd Floor, Clinical Center, C90, Jacksonville, FL 33209
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Nanthakumar H, Iwanaga J, Dumont AS, Tubbs RS. A rare cadaveric case of a duplicated internal thoracic artery. Anat Cell Biol 2020; 53:366-368. [PMID: 32727954 DOI: 10.5115/acb.20.054] [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: 03/13/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022] Open
Abstract
The internal thoracic artery (ITA) arises from the subclavian artery and terminates as the musculophrenic and inferior epigastric arteries. During routine cadaveric dissection, an aberrant left ITA was discovered. A medial and a lateral branch of the ITA branched directly off the subclavian artery as opposed to bifurcating at the 6th or 7th intercostal space. To our knowledge, this is the first reported case of this particular ITA variation arising from the third part of the subclavian artery. Additionally, such a variant might also be considered a high bifurcation of the ITA. Our report examines this variation and its potential implications for coronary artery bypass grafts where the ITA is commonly used.
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Affiliation(s)
- Harry Nanthakumar
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Nanthakumar H, Iwanaga J, Dumont AS, Tubbs RS. A rare cadaveric case of a duplicated internal thoracic artery. Anat Cell Biol 2020; 53. [PMID: 32727954 PMCID: PMC7527130 DOI: 10.25373/ctsnet.7611560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The internal thoracic artery (ITA) arises from the subclavian artery and terminates as the musculophrenic and inferior epigastric arteries. During routine cadaveric dissection, an aberrant left ITA was discovered. A medial and a lateral branch of the ITA branched directly off the subclavian artery as opposed to bifurcating at the 6th or 7th intercostal space. To our knowledge, this is the first reported case of this particular ITA variation arising from the third part of the subclavian artery. Additionally, such a variant might also be considered a high bifurcation of the ITA. Our report examines this variation and its potential implications for coronary artery bypass grafts where the ITA is commonly used.
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Affiliation(s)
- Harry Nanthakumar
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA,Corresponding author: Joe Iwanaga Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA E-mail:
| | - Aaron S. Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA,Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, West Indies
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Ismagilov A, Vanesyan A, Ovchinnikova I, Khamitov A, Basiashvili G, Zinchenko S. New technique of dissection of internal mammary vessels for breast reconstruction. Gland Surg 2020; 9:886-892. [PMID: 32953597 DOI: 10.21037/gs-20-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although internal mammary vessels are considered the best recipients for free flap breast reconstruction, they present the notable drawback of limited accessibility. The aim of this study was to develop a minimally invasive surgical technique for the dissection of internal mammary vessels as recipients for breast reconstruction. Methods From 2008 to 2018, we performed 32 unilateral microsurgical breast reconstructions (mean patient age: 40.1±8.7 years; range, 23-58 years). As internal mammary vessels were exclusively used as recipients, they were dissected using a technique of minimally invasive video-assisted thoracoscopic surgery (VATS) developed in our hospital. Results The mean surgery time was 5.4±0.55 hours (range, 4.5-6.5 hours), and the mean duration of VATS dissection of internal mammary vessels was 20.6±2.9 minutes (range, 16-27 minutes). Of the specific complications associated with VATS, we only observed reductions in forced expiratory volume in the first second of >15% in 3 patients (9.4%), 10-15% in 8 patients (25%), and <10% in 21 patients (65.63%). We did not have any cases of significant bleeding or postoperative infection in this series of patients. With regard to aesthetic complications, we observed 1 and 2 cases of total necrosis and partial necrosis of the deep inferior epigastric perforator (DIEP) flap, respectively and 2 cases of partial necrosis of supercharged transverse rectus abdominis muscle flap. Conclusions Endoscopic dissection of internal mammary vessels is a simple and feasible technique. When performed by experienced surgeons, it is a fast procedure that is associated with low rate of complications.
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Affiliation(s)
- Arthur Ismagilov
- Department of Surgery, Kazan Federal University, Kazan, Russia.,Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Anna Vanesyan
- Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Irina Ovchinnikova
- Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Airat Khamitov
- Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - George Basiashvili
- Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Sergei Zinchenko
- Department of Surgery, Kazan Federal University, Kazan, Russia.,Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
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Maskell P, Oo S, Muir AD, Fan KS, Harky A. Techniques and approaches for revascularisation of left heart coronary diseases. Br J Hosp Med (Lond) 2020; 81:1-11. [PMID: 32845756 DOI: 10.12968/hmed.2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease and its associated clinical sequelae are a significant medical burden to clinicians and patients. Severe coronary artery disease presenting in the context of acute myocardial ischaemia, or stable plaques causing chronic symptoms despite best conservative and pharmacological intervention, are often amenable to further intervention such as coronary artery bypass grafting. This procedure has been extensively compared to newer and less invasive techniques, such as percutaneous coronary intervention, and other minimally invasive procedures such as robotic or endoscopic techniques. This review summarises the current evidence on revascularisation of the left coronary artery system, with particular emphasis on key clinical endpoints of mortality, myocardial infarction, stroke and repeat revascularisation.
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Affiliation(s)
- Perry Maskell
- Department of Medical Education, Countess of Chester Hospital, Chester, UK
| | - Shwe Oo
- Department of Cardiothoracic Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Andrew D Muir
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Ka Siu Fan
- St. George's Medical School, University of London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.,Institute of Integrative Biology, University of Liverpool, Liverpool, UK
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López de la Cruz Y. Some considerations regarding the history of internal mammary artery harvesting. J Card Surg 2020; 35:2110. [PMID: 32484947 DOI: 10.1111/jocs.14679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022]
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10
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Harky A, Bin Saeid J. Internal mammary harvesting: The long‐lasting history and harvesting techniques. J Card Surg 2020; 35:2111. [DOI: 10.1111/jocs.14683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Liverpool UK
- University of Liverpool Liverpool UK
| | - Jalal Bin Saeid
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Liverpool UK
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