Composite Total Arterial Revascularization Techniques Comparing Second Internal Mammary Artery And Radial Artery

A case of bilateral coronary ostial aortoarteritis, which presented with angina pectoris, is reported. Emergency total arterial revascularization was performed using the bilateral mammary artery and radial artery, and the radial artery was hanged “Y” on the left internal mammary artery. The patient was discharged on low-dose steroid. He was asymptomatic at 1-year follow-up.

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Total Arterial Revascularization with Composite Y/T Grafts: Comparison of Early and Long-Term Outcomes of Bilateral Internal Mammary Arteries with Left Internal Mammary-Radial Artery Composite Grafts

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0035-1544345 ◽

2015 ◽

Vol 63 (S 01) ◽

Author(s):

P. Davierwala ◽

K. Penov ◽

M. Mende ◽

P. Amorim ◽

B. Ferreira ◽

...

Keyword(s):

Radial Artery ◽

Long Term Outcomes ◽

Arterial Revascularization ◽

Total Arterial Revascularization ◽

Composite Grafts ◽

Mammary Arteries ◽

Internal Mammary

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How do surgeons decide? Conduit choice in coronary artery bypass graft surgery in the UK

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz047 ◽

2019 ◽

Vol 29 (2) ◽

pp. 179-186 ◽

Cited By ~ 8

Author(s):

Shruti Jayakumar ◽

Marisa Gasparini ◽

Tom Treasure ◽

Clare Burdett ◽

Felix Jozsa ◽

...

Keyword(s):

Decision Making ◽

Internal Mammary Artery ◽

Artery Bypass ◽

High Quality ◽

Arterial Revascularization ◽

Total Arterial Revascularization ◽

High Quality Evidence ◽

Internal Mammary ◽

The Uk ◽

Quality Evidence

Abstract OBJECTIVES Conduits used in coronary artery bypass grafting may have significant impact on outcomes, but evidence is mixed and there is large variation in practice. This study provides insights into the opinions of the UK surgeons on conduit use and their decision-making processes. METHODS A questionnaire was created using the Ottawa Decision Support Framework to elicit the importance that surgeons placed on bilateral internal mammary artery grafting, skeletonization, total arterial revascularization and sequential anastomoses on a scale of 1–10. Scores ≥8 were deemed ‘important’ and ≤3 ‘not important’. Surgeons were asked to specify changes to practice in frail patients or emergencies. Additional questions included conduit type used, factors affecting decision-making and vein harvesting methods. Questionnaires were administered in person with data analysed centrally. RESULTS Ninety-seven consultant cardiac surgeons from 25 centres responded. Thirty-two percent surgeons routinely used radial arteries and 36% used right internal mammary artery. High-quality evidence contributed most to decision-making receiving a total of 328/960 points, with consultant experience being the second (255/960 points). There was a bimodal distribution of perceived importance of bilateral internal mammary artery use, with 29 (30%) ‘important’ and ‘not important’ scores each. 23% of surgeons found total arterial revascularization important. Most surgeons (64%) preferred pedicled mammary arteries. Twenty-six percent of surgeons considered sequential grafting to be important. CONCLUSIONS Low uptake of total arterial revascularization and bilateral internal mammary artery among the UK consultants may be due to the lack of high-quality evidence demonstrating a significant benefit. It is also possible that reluctance to use certain conduits may stem from low levels of exposure to conduits or inadequate training, particularly given the importance of consultant experience on decision-making.

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Prediction value of EuroSCORE II in total arterial revascularization and its usage in the evaluation of postoperative complications: Single-center experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997057 ◽

2021 ◽

pp. 021849232199705

Author(s):

Aleksandar V Milutinovic ◽

Stasa D Krasic ◽

Igor S Zivkovic ◽

Andja M Cirkovic ◽

Slobodan Z Lokas ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Arterial Revascularization ◽

Total Arterial Revascularization ◽

Mammary Arteries ◽

Internal Mammary

Background Total arterial revascularization is the most durable and technically the most demanding type of coronary artery bypass grafting procedure. It has proven long-term supremacy in comparison to conventional coronary artery bypass grafting. In our study, we investigated the reliability of EuroSCORE II as a predictor of intrahospital death. We showed its impact on adverse perioperative events. Methods In this nonrandomized prospective study, we analyzed 116 consecutive patients who underwent the total arterial revascularization procedure at our Institute from January 2011 until the present. For myocardial revascularization, the most suitable combinations with left internal mammary artery, right internal mammary artery, and radial artery grafts were used. Main fact in this research was intrahospital mortality value in comparison with the value predicted. Results There were 104 (89.7%) males and 12 (10.3%) females. Mean preoperative EuroSCORE II prediction value was 1.98% and postoperative we obtained 1.72%. Postoperative redo for bleeding was 6%. Positive correlation was proven between the EuoroSCORE II value and intensive care unit stay (0.452; p < 0.001). Among patients who received two internal mammary arteries, the highest EuroSCORE II was among those with presternal wound infection (p = 0.005). Patients with bilateral internal mammary arteries and diabetes showed that they have the highest values of EuroSCORE II and, at the same time, that they are extremely prone to wound problems. Conclusions We achieved a lower intrahospital mortality level than it was predicted with preoperative EuroSCORE II value. This tool is a reliable method for preoperative death risk calculation in this group of patients.

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EARLY OUTCOMES

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.05.1588 ◽

2016 ◽

Vol 23 (05) ◽

pp. 583-588

Author(s):

Tayyab Pasha ◽

Rafaqat Ahmed ◽

Muhammad Amir ◽

Amir Iqbal ◽

Ayesha Siddiqa

Keyword(s):

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Arterial Grafts ◽

Arterial Revascularization ◽

Off Pump ◽

Total Arterial Revascularization ◽

Internal Mammary ◽

Acute Mi ◽

Artery Disease ◽

Vessel Coronary Artery

Objectives: Off pump TACR/MACR performed in experienced hands hascomparable results to on pump TACR/MACR. Period: January-2012 to December-2015.Material and method: 405 patients with two and three vessel coronary artery disease (two &three VCAD) underwent OPCAB at the department of cardiac surgery, Jinnah hospital, Lahore.73 of them got total or multiple arterial coronary revascularizations. 34 patients (41%) hadtwo VCAD and 47 (59%) had three VCAD. Total arterial revascularization was performed in 70(95.8%) patients using right internal mammary artery and left internal mammary artery and/orradial artery. 3 (4.10%) patients got multiple arterial grafts using BITA, RA and SVG. Results:There was no death reported in first 30 days post operatively. Deep sternal wound infectionoccurred in only one patient. The rate of perioperative stroke and renal failure was zero. Two(2.46%) patients had acute MI and 1 patient was reopened due to bleeding. Conclusion: Weconclude that early outcome of OPCAB total or multiple arterial coronary revascularizations, inexperienced hands, are as safe and effective as ONCAB.

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