1
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Olsthoorn JR, Verberkmoes N. Coronary subclavian steal. Neth Heart J 2024; 32:100. [PMID: 36995642 PMCID: PMC10834904 DOI: 10.1007/s12471-023-01772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
| | - Niels Verberkmoes
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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2
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Vallely MP, Seco M, Ramponi F, Puskas JD. Total-arterial, anaortic, off-pump coronary artery surgery: Why, when, and how. JTCVS Tech 2021; 10:140-148. [PMID: 34977717 PMCID: PMC8691864 DOI: 10.1016/j.xjtc.2021.09.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Michael P. Vallely
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael Seco
- Department of Cardiothoracic Surgery, The Children's Hospital at Westmead, Sydney, Australia
| | - Fabio Ramponi
- Department of Cardiothoracic Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - John D. Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, NY
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3
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Pillai VV, Sreekanthan R, Karunakaran J. Quantitative estimation of LIMA blood flow between extraluminal papavarine vs extraluminal papavarine plus intraluminal vasodilator cocktail in CABG patients. Ann Card Anaesth 2020; 23:414-418. [PMID: 33109796 PMCID: PMC7879920 DOI: 10.4103/aca.aca_164_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: In this study, we aimed at a comparative quantitative estimation of the difference in LIMA blood flow between LIMAs treated with topical papaverine alone and LIMAs treated with a combination of topical papaverine plus an intraluminal cocktail of papaverine, nitroglycerine, and milrinone. Methods: Nearly 50 consecutive patients with similar demographics undergoing elective on-pump CABG were recruited for the study. After pedicled LIMA harvest, topical papaverine was sprayed on the pedicle and kept enveloped in papaverine soaked gauze. LIMA flow was then estimated. Later, intraluminal vasodilator solution of papaverine, NTG, milrinone, and heparinized blood were instilled in LIMA, and LIMA flows were estimated. Results: The mean LIMA flows with topical papaverine alone was 47.19 mL/min whereas the mean LIMA flows with topical papaverine plus intraluminal cocktail was 104 mL/min. There was a significant difference between the two flows as their mean was 56.815 mL/min and the paired t-test for significance had a P value of 0.0001. Conclusion: There was a significant difference in the LIMA flow when the LIMA had been treated with the intraluminal instillation of the vasodilator cocktail in addition to the topical application of papaverine solution. Therefore, intraluminal vasodilator cocktail of milrinone, NTG, and papaverine mixed with heparinized blood in addition to topical papaverine is a simple and effective method for LIMA preparation in CABG.
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Affiliation(s)
- Vivek V Pillai
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Renjith Sreekanthan
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jayakumar Karunakaran
- Department of Cardiothoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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4
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Jannati M, Navaei MR, Ronizi LG. A comparative review of the outcomes of using arterial versus venous conduits in coronary artery bypass graft (CABG). J Family Med Prim Care 2019; 8:2768-2773. [PMID: 31681641 PMCID: PMC6820417 DOI: 10.4103/jfmpc.jfmpc_367_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/05/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023] Open
Abstract
Nowadays one of the most frequent reasons of death in the world is coronary artery disease. CABG is a portion of a common revascularization mediation that is done to supervise CAD by applying vessels that are grafted to revascularize vessels distal from the blockage. Different sources of grafts are included veins (specifically saphenous) and arteries (include mammary and radial arteries). Multiple conduits are used to this end, but the most suitable is left internal mammary artery (LIMA) to the left anterior descending artery (LAD) as a golden standard. Saphenous vein grafts were the guiding approach applied by the vast majority of cardiac surgeons in the 1970s, even though all approaches were supported by doctors. Although the radial artery graft was introduced simultaneously, this approach due to its complications was not as prevalent. This article is aimed to define the pros and cons of applying each kind of grafts according to the results furnished by existent studies. It has also examined the benefits provided by total arterial coronary artery bypass graft against CABG including venous graft for patients with CAD from the perspective of surgeons.
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Affiliation(s)
- Mansour Jannati
- Department of Cardiovascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Rafati Navaei
- Department of Cardiovascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ghaedian Ronizi
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
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5
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Tinica G, Chistol RO, Bulgaru Iliescu D, Furnica C. Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Exp Ther Med 2019; 17:359-367. [PMID: 30651804 PMCID: PMC6307371 DOI: 10.3892/etm.2018.6929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/11/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.
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Affiliation(s)
- Grigore Tinica
- Department of Cardiovascular Surgery, 'Prof. Dr. George I.M. Georgescu' Cardiovascular Diseases Institute, 700503 Iasi, Romania.,Discipline of Cardiac Surgery, Department of Surgery I, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Raluca Ozana Chistol
- Department of Medical Imaging, 'Prof. Dr. George I.M. Georgescu' Cardiovascular Diseases Institute, 700503 Iasi, Romania
| | - Diana Bulgaru Iliescu
- Discipline of Forensic Medicine, Medical Department III, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Institute of Forensic Medicine, 700455 Iasi, Romania
| | - Cristina Furnica
- Institute of Forensic Medicine, 700455 Iasi, Romania.,Discipline of Anatomy, Department of Morpho-Functional Sciences I, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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6
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Yuan B, Qi HW, Zhao JG, Wang XZ, Chen N, Zhao FH, Wang LF, Dong HY. Total Arterial Off-Pump Coronary Artery Bypass Grafting: A 10-Year Experience. Chin Med J (Engl) 2018; 131:2179-2184. [PMID: 30203792 PMCID: PMC6144839 DOI: 10.4103/0366-6999.240796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up. Methods: From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts. Results: The average distal anastomosis was 2.34 ± 0.97 (range: 1–4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population. Conclusions: Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.
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Affiliation(s)
- Biao Yuan
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hong-Wei Qi
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jian-Gang Zhao
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xi-Zheng Wang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Nan Chen
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Feng-Hua Zhao
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li-Fang Wang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Huan-Ying Dong
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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7
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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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8
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Belov YV, Lysenko AV, Komarov RN, Stonogin AV. [Multiple coronary artery bypass grafting using internal mammary artery]. Khirurgiia (Mosk) 2016:81-86. [PMID: 27070883 DOI: 10.17116/hirurgia2016381-86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yu V Belov
- Chair of Cardiovascular Surgery and Interventional Cardiology, I.M. Sechenov First Moscow State Medical University; acad. B.V. Petrovsky Russian Research Center of Surgery, Moscow
| | - A V Lysenko
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, I.M. Sechenov First Moscow State Medical University; Chair of Cardiovascular Surgery and Interventional Cardiology, I.M. Sechenov First Moscow State Medical University
| | - R N Komarov
- Chair of Cardiovascular Surgery and Interventional Cardiology, I.M. Sechenov First Moscow State Medical University
| | - A V Stonogin
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, I.M. Sechenov First Moscow State Medical University; Chair of Cardiovascular Surgery and Interventional Cardiology, I.M. Sechenov First Moscow State Medical University
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9
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Affiliation(s)
- O P Yadava
- C.E.O. & Chief Cardiac Surgeon, National Heart Institute, New Delhi, India.
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10
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Apostolakis E, Papakonstantinou NA, Chlapoutakis S, Prokakis C. Save or sacrifice the internal mammary pedicle during anterior mediastinotomy? Ann Thorac Med 2014; 9:138-43. [PMID: 24987471 PMCID: PMC4073569 DOI: 10.4103/1817-1737.134067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/17/2013] [Indexed: 12/03/2022] Open
Abstract
Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.
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Affiliation(s)
- Efstratios Apostolakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Nikolaos A Papakonstantinou
- Department of General Surgery, General Oncology Hospital of Kifissia "Agioi Anargyroi", 41 Kaliftaki Street, P.C. 14564, Kifissia, Athens, Greece
| | - Serafeim Chlapoutakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Christos Prokakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
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11
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Barner HB. Conduits for coronary bypass: strategies. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:319-27. [PMID: 24175266 PMCID: PMC3810553 DOI: 10.5090/kjtcs.2013.46.5.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 01/02/2023]
Abstract
Strategic planning is integral to any operation but complexity varies immensely and therefore the effort necessary to create the optimal plan. The previous three reports have discussed individual conduits and herein is an attempt to present approaches to common situations which the author favors. Although much has been learned over 45 years about use and subsequent behavior of venous and arterial grafts we continue to learn and, as a result, evolve new strategies or modify those now popular. Thus the reader must recognize that in spite of trying to be balanced and inclusive all surgeons have personal opinions and also prejudices which influence the approach taken and which may not be the optimal one for others or for the patient.
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Affiliation(s)
- Hendrick B Barner
- Division of Cardiothoracic Surgery, St. Louis University Hospital, USA
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