REPLY: Coronary Artery Bypass Grafting Using Both Internal Mammary Arteries: Why Waste the Right Internal Mammary Artery Proximal Stump?

Background The gold standard for coronary artery bypass grafting to the left anterior descending artery is use of the left internal mammary artery. Better long-term survival has been reported using bilateral internal mammary arteries compared to left internal mammary artery only, but many surgeons are reluctant to employ bilateral internal mammary arteries in coronary artery bypass grafting. This study aimed to evaluate the effectiveness and safety of bilateral internal mammary artery use. Methods From 2014 to 2017, 1703 patients underwent coronary artery bypass grafting in our institute. Of these, 772 met the inclusion criteria and were randomly assigned to receive bilateral ( n = 387) or left ( n = 385) internal mammary artery grafts. The mean age was 67.1 ± 6.0 years (range 48–85 years) and 474 (61.4%) were male. The mean number of diseased vessels was 3.1 ± 0.9, and mean EuroSCORE II was 3.4% ± 1.1%. Results Hospital mortality was 1.2% in the left internal mammary artery group vs. 1.8% in the bilateral internal mammary artery group ( p = 0.55). There was no difference in procedure-related complications between groups. Mean follow-up was 65.9 months. Survival in the bilateral internal mammary artery group at 1, 3, and 5 years was 98.7%, 98.7%, and 94.8% vs. 98.1%, 98.1%, and 90.9%, respectively, in the left internal mammary artery group ( p = 0.63). Conclusion Application of bilateral internal mammary arteries in coronary artery bypass grafting is safe and effective, with comparable midterm results to those with the left internal mammary artery only.

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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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Acute pleuropulmonary complications detected by computed tomography following myocardial revascularization

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812002000400003 ◽

2002 ◽

Vol 57 (4) ◽

pp. 135-142 ◽

Cited By ~ 10

Author(s):

Francisco S. Vargas ◽

Kiyomi K. Uezumi ◽

Fabio B. Janete ◽

Mario Terra-Filho ◽

Whady Hueb ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Saphenous Vein ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary ◽

The Right

INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma. METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy). Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2) and seventh (day 7) postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points. RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P < 0.05). The incidence of effusions on day 2 in the saphenous vein graft group (87.5%) was higher (P < 0.05) than in the internal mammary artery group (52.3%). The incidence of atelectasis in the lower right lobe decreased (P < 0.05) from 86.7% (day 2) to 26.7% (day 7). The degree of atelectasis in both sides did not differ on day 2 (P = 0.42) but did on day 7 (P < 0.0001). There was a decrease in the atelectasis from day 2 to day 7 on the right side (P < 0.001), but not on the left (P = 0.21). On day 2 there was a relationship between atelectasis and effusion on the right (P = 0.04), but not on the left (P = 0.113). CONCLUSION: The present series demonstrates that there is a high incidence of both minimal pleural effusion and atelectasis after coronary artery bypass grafting surgery, which drops on the right side from day 2 to day 7 post surgery. Factors that contribute to the persistence of changes on the left side include the thoracic trauma and the presence of chest tubes and pericardial effusion.

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Commentary: Bilateral Versus Single Internal Mammary Arteries in Diabetic Patients Undergoing Coronary Artery Bypass Grafting—Is There a Sweet Spot?

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.10.029 ◽

2020 ◽

Author(s):

Dinela Rushani ◽

Derrick Y Tam ◽

Stephen E. Fremes

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Diabetic Patients ◽

Bypass Grafting ◽

Sweet Spot ◽

Artery Bypass Grafting ◽

Mammary Arteries ◽

Internal Mammary

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Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair

The Heart Surgery Forum ◽

10.1532/hsf.1359 ◽

2016 ◽

Vol 19 (1) ◽

pp. 033

Author(s):

Takahiro Taguchi ◽

Jeswant Dillon ◽

Mohd Azhari Yakub

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Mitral Valve ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Valve Repair ◽

Artery Bypass Grafting ◽

Internal Mammary

A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.

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