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Prapas S, Katsavrias K, Gaudino M, Puskas JD, Di Mauro M, Zografos P, Guarracini S, Linardakis I, Panagiotopoulos I, Di Marco M, Papandreopoulos S, Pomakidou S, Totaro A, Calafiore AM. Saphenous vein to the right coronary system from the right thoracic artery or the aorta. Long-term propensity-matched results of 2 groups. Eur J Cardiothorac Surg 2024; 65:ezae060. [PMID: 38400814 DOI: 10.1093/ejcts/ezae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Since 2000, we anastomosed the saphenous vein graft to the right coronary artery system using the stump of the right internal thoracic artery as inflow. The long-term results of patients where the right coronary artery was grafted with the right internal thoracic artery or the ascending aorta as saphenous vein inflow has not been reported. METHODS From 2000 to 2018, 699 consecutive patients had right internal thoracic artery elongated with saphenous vein (I-graft group, n = 358, 51.2%) or saphenous vein from the aorta (Ao-graft group, n = 341, 48.8%) on right coronary artery system. Inclusion criteria were age ≤75 years, bilateral internal thoracic arteries as a Y graft on the left system (three-vessel disease, n = 603, 86.3%) or as a left internal thoracic artery on left anterior descending and right internal thoracic artery elongated with saphenous vein on the right coronary artery system (two-vessel disease, n = 96, 13.7%), only 1 saphenous vein per patient. Propensity-matching identified 272 patients per group. One-hundred and twenty-two patients underwent coronary computed tomographic angiography to asses grafts patency after a median follow-up of 88 (65-93) months. RESULTS In the paired samples, there was no difference in the early outcome. Ten-year survival and freedom from death, non-fatal acute myocardial infarction and repeat revascularization were higher in I-graft group: 90.6 [standard error (SE): 2.0] vs 78.2 (SE: 5.3), P = 0.0266, and 85.2 (SE: 2.4) vs 69.9 (SE: 5.3), P = 0.0179. Saphenous vein graft, at a long-time follow-up, showed a higher patency rate (81.6% (SE: 7.0) vs 50.7% (SE: 7.9), P < 0.0001) and a smaller internal lumen diameter (2.7, standard deviation: 0.4 vs 3.4, standard deviation: 0.6 mm, P < 0.0001) when right internal thoracic artery was the inflow. CONCLUSIONS Grafting the right coronary artery with saphenous vein may entail higher patency rate and better outcome when the inflow is the right internal thoracic artery than when is the ascending aorta. Prospective randomized data are needed to test this hypothesis.
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Affiliation(s)
- Sotirios Prapas
- 1st Department of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
- Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy
| | | | | | - Ioannis Linardakis
- 1st Department of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | | | | | | | - Antonio Totaro
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Kou Z, Mao R, Gan Y, Zhang Y, Li B, Kou X, Xie J, Zhang L, Liang T, Xie D, Wang Y. Four case reports of left anterior descending restenosis treated via the internal mammary artery: A literature review. Heliyon 2024; 10:e25694. [PMID: 38390163 PMCID: PMC10881538 DOI: 10.1016/j.heliyon.2024.e25694] [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: 11/09/2022] [Revised: 11/22/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Objective To analyse four cases of intervention via the internal mammary artery-anterior descending branch and provide and summarise the clinical treatment experience. Methods The clinical data of four patients with distal restenosis of a left anterior descending artery (LAD) anastomosis after left internal mammary artery (LIMA)-LAD bypass surgery, who were admitted to the Gansu Institute of Cardiovascular Diseases between March 2013 and April 2022, were retrospectively analysed and reviewed together with the relevant literature. Results Among the four patients, one was treated with intracoronary stenting via the internal mammary artery route, two were treated with intracoronary drug-coated balloon dilation (one of whom underwent fractional flow reserve [FFR] testing), and two underwent FFR testing (one of whom had a negative test result until the end of the procedure and continued to take medication during follow-up; the other patient had a positive result and further interventions). There were no deaths or postoperative complications in the group, and the patients were followed up for 4 months to 9 years, with good long-term outcomes. Conclusion Percutaneous coronary intervention (PCI) via the internal mammary artery route is safe and effective, and patients with anastomotic distal stenosis or anastomotic stenosis of LAD bypass anastomosis may be considered for PCI via the internal mammary artery route.
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Affiliation(s)
- Zongke Kou
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
- Deparment of Cardiovascular surgery, The First people's Hospital of Lanzhou City, Lanzhou, 730050, China
| | - Rui Mao
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Yirong Gan
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
- Deparment of Cardiovascular surgery, The First people's Hospital of Lanzhou City, Lanzhou, 730050, China
| | - Yunlong Zhang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Bing Li
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Xiaoqing Kou
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Jing Xie
- Deparment of Functional Examination Section, The First people's Hospital of Lanzhou City, Lanzhou, 730050, China
| | - Liying Zhang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Tianxiang Liang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
| | - Dingxiong Xie
- Deparment of Cardiovascular surgery, The First people's Hospital of Lanzhou City, Lanzhou, 730050, China
| | - Yanzhen Wang
- Gansu Institute of Cardiovascular Diseases, Lanzhou, 730050, China
- Deparment of Cardiovascular surgery, The First people's Hospital of Lanzhou City, Lanzhou, 730050, China
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Stevens LM, Chartrand-Lefebvre C, Mansour S, Béland V, Soulez G, Forcillo J, Basile F, Prieto I, Noiseux N. Anterolateral territory coronary artery bypass grafting strategies: a non-inferiority randomized clinical trial: the AMI-PONT trial. Eur J Cardiothorac Surg 2023; 63:ezad060. [PMID: 36805638 PMCID: PMC10133400 DOI: 10.1093/ejcts/ezad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/09/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES The main objective was to assess whether a composite coronary artery bypass grafting strategy including a saphenous vein graft bridge to distribute left internal mammary artery outflow provides non-inferior patency rates compared to conventional grafting surgery with separated left internal mammary artery to left anterior descending coronary graft and aorto-coronary saphenous vein grafts to other anterolateral targets. METHODS All patients underwent isolated grafting surgery with cardiopulmonary bypass and received ≥2 grafts/patients on the anterolateral territory. The graft patency (i.e. non-occluded) was assessed using multislice spiral computed tomography at 1 year. RESULTS From 2012 to 2021, 208 patients were randomized to a bridge (n = 105) or conventional grafting strategy (n = 103). Patient characteristics were comparable between groups. The anterolateral graft patency was non-inferior in the composite bridge compared to conventional grafting strategy at 1 year [risk difference 0.7% (90% confidence interval -4.8 to 6.2%)]. The graft patency to the left anterior descending coronary was no different between groups (P = 0.175). Intraoperatively, the bridge group required shorter vein length for anterolateral targets (P < 0.001) and exhibited greater Doppler flow in the mammary artery pedicle (P = 0.004). The composite outcome of death, myocardial infarction or target vessel reintervention at 30 days was no different (P = 0.164). CONCLUSIONS Anterolateral graft patency of the composite bridge grafting strategy is non-inferior to the conventional grafting strategy at 1 year. This novel grafting strategy is safe, efficient, associated with several advantages including better mammary artery flow and shorter vein requirement, and could be a valuable alternative to conventional grafting strategies. Ten-year clinical follow-up is underway. TRIAL REGISTRATION ClinicalTrials.gov: NCT01585285.
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Affiliation(s)
- Louis-Mathieu Stevens
- Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
| | - Carl Chartrand-Lefebvre
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Samer Mansour
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
- Division of Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Gilles Soulez
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Jessica Forcillo
- Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
| | - Fadi Basile
- Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Ignacio Prieto
- Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- CHUM Research Centre (CRCHUM), Montreal, QC, Canada
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Pesce M, Pompilio G, Bartunek J. The LIMA: A Drug-Eluting Graft and Coronary Flow Shock Absorber. Mayo Clin Proc 2023; 98:15-17. [PMID: 36603942 DOI: 10.1016/j.mayocp.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 01/04/2023]
Affiliation(s)
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Università di Milano, Milan, Italy
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Shadrin IY, Holmes DR, Behfar A. Left Internal Mammary Artery as an Endocrine Organ: Insights Into Graft Biology and Long-term Impact Following Coronary Artery Bypass Grafting. Mayo Clin Proc 2023; 98:150-162. [PMID: 36603943 DOI: 10.1016/j.mayocp.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/30/2022] [Accepted: 10/05/2022] [Indexed: 01/04/2023]
Abstract
The left internal mammary artery (LIMA) is considered the criterion standard vessel for use in coronary artery bypass grafting. In recent decades, countless studies have documented its superiority over other arterial and venous coronary artery bypass grafting conduits, although the full mechanisms for this superiority remain unknown. A growing body of literature has unveiled the importance of extracellular vesicles known as exosomes in cardiovascular signaling and various pathologic states. In this review, we briefly compare the clinical longevity of the LIMA relative to other conduits, explore the effects of varying grafting techniques on clinical and angiographic outcomes, and provide physiologic insights into graft function on a cellular and molecular level. Finally, we explore exosome signaling as it pertains to atherosclerosis in support of the LIMA as an "endocrine organ."
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Affiliation(s)
- Ilya Y Shadrin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Van Cleve Cardiac Regenerative Medicine Program, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN.
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Li D, Guo Y, Gao Y, An X, Liu Y, Gu S, Zhang X, Zhong J, Gao J, Su P. One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease. Front Cardiovasc Med 2021; 8:755797. [PMID: 34977178 PMCID: PMC8718508 DOI: 10.3389/fcvm.2021.755797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Data on one-stop hybrid coronary revascularization (HCR) are limited. This study aimed to compare the early and midterm outcomes of one-stop HCR with off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease. Methods: From April 2018 to May 2021, 752 patients with multivessel coronary artery disease who underwent isolated one-stop HCR or OPCAB were retrospectively included in this analysis. After exclusion and propensity score matching, 151 patients who underwent HCR were matched with 151 patients who underwent OPCAB. The primary endpoints were midterm major adverse cardiovascular and cerebrovascular events (MACCE) after the procedure. The secondary endpoints were in-hospital complications and outcomes. Results: The preprocedural characteristics were well balanced between the two groups after matching. The HCR group was associated with a lower rate of perioperative transfusion (23.8 vs. 53.0%, p < 0.001) and new-onset atrial fibrillation (AF) (5.3 vs. 15.2%, p = 0.004), shorter time of mechanical ventilation (h) [15 (16, 17) vs. 17 (16, 20), p < 0.001], and shorter length of stay (LOS) in the hospital (days) [19 (16, 24) vs. 22 (18, 27), p = 0.001]. Cumulated MACCE rates were similar between the two groups (15.9 vs. 14.0%, p = 0.59) during a median follow-up of 20 months. Conclusions: One-stop HCR is safe and efficacious with less invasiveness and faster postoperative recovery in selected patients with multivessel coronary artery disease. Randomized controlled trials with larger sample sizes and long-term follow-up are warranted to confirm these findings.
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Affiliation(s)
- Dongjie Li
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yulin Guo
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingdi Gao
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangguang An
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Song Gu
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xitao Zhang
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiuchang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Gao
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Jie Gao
| | - Pixiong Su
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Pixiong Su
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