Total Arterial Revascularization with Bilateral Internal Thoracic Artery: A long-term, Propensity Score-matched Comparison of Composite Y - BITA - Grafts to BITA - in situ Grafting

2016 ◽  
Vol 64 (S 01) ◽  
Author(s):  
P. Davierwala ◽  
K. Penov ◽  
M. Baiocchi ◽  
M. Aydin ◽  
M. Zoric ◽  
...  
Keyword(s):  
Propensity Score ◽  
Internal Thoracic Artery ◽  
Arterial Revascularization ◽  
Total Arterial Revascularization ◽  
Bilateral Internal Thoracic Artery ◽  
Matched Comparison

A Novel Subxiphoid Approach for Bilateral Internal Thoracic Artery Harvesting

2021 ◽  
pp. 155698452098106
Author(s):  
Hossein Amirjamshidi ◽  
Jude S. Sauer ◽  
Bryan Barrus ◽  
Peter A. Knight ◽  
Sunil M. Prasad
Keyword(s):  
Minimally Invasive ◽  
Porcine Model ◽  
Internal Thoracic Artery ◽  
Experimental Testing ◽  
Bypass Graft ◽  
Arterial Revascularization ◽  
Early Results ◽  
Tissue Manipulation ◽  
Bilateral Internal Thoracic Artery

Objective Bilateral internal thoracic artery (BITA) bypass can enable more complete arterial revascularization procedures. Minimally invasive cardiac surgery (MICS) can offer significant patient benefits. New minimally invasive technology for sternal retraction and tissue manipulation is needed to enable ergonomic and reliable minimally invasive ITA harvesting. The goal of this research was to develop technology and techniques, along with experimental testing and training models, for a sternal-sparing approach to in situ BITA harvesting through a small subxiphoid access site. Methods This study focused on optimizing custom equipment and methods for subxiphoid BITA harvesting initially in a porcine model (19 pig carcasses, 36 ITAs) and subsequently in 7 cadavers (14 ITAs). Results Fifty consecutive ITAs were successfully harvested using this remote access approach. The last 20 ITA specimens harvested from the porcine model were explanted and measured; the average length of the free ITA grafts was 12.8 ± 0.9 cm (range 10.8 to 14.2 cm) with a mean time of 23.3 ± 5.2 minutes (range 13 to 25 minutes) for each harvest. Conclusions Early results demonstrate that both ITAs can be reliably harvested in a skeletonized fashion in situ through sternal-sparing, small subxiphoid access in 2 experimental models. This innovative approach warrants further exploration toward facilitating complete arterial revascularization and the further adoption of minimally invasive coronary artery bypass graft surgery.

scholarly journals Bilateral internal thoracic artery grafting: Long-term clinical and angiographic results of in situ versus Y grafts

2000 ◽  
Vol 120 (5) ◽  
pp. 990-998 ◽  
Author(s):  
Antonio Maria Calafiore ◽  
Marco Contini ◽  
Giuseppe Vitolla ◽  
Michele Di Mauro ◽  
Valerio Mazzei ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Bilateral Internal Thoracic Artery

Bilateral Internal Thoracic Artery In Situ Versus Y-Composite Graftings: Long-term Outcomes

2020 ◽  
Vol 109 (6) ◽  
pp. 1773-1780 ◽  
Author(s):  
Suk Ho Sohn ◽  
Yeiwon Lee ◽  
Jae Woong Choi ◽  
Ho Young Hwang ◽  
Ki-Bong Kim
Keyword(s):  
Internal Thoracic Artery ◽  
Long Term Outcomes ◽  
Bilateral Internal Thoracic Artery

scholarly journals Bilateral Internal Thoracic Artery Grafting in Women: A Word of Caution

2019 ◽  
Vol 22 (1) ◽  
pp. E045-E049 ◽  
Author(s):  
Thibaut Schoell ◽  
Laurent Genser ◽  
Marina Clément ◽  
Julien Amour ◽  
Pascal Leprince ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Internal Thoracic Artery ◽  
Myocardial Revascularization ◽  
Deep Sternal Wound Infection ◽  
Complete Revascularization ◽  
Arterial Revascularization ◽  
Total Arterial Revascularization ◽  
Increased Risk ◽  
Bilateral Internal Thoracic Artery ◽  
The Impact

Background: Despite the superior hemodynamic performance of internal thoracic arteries, total arterial revascularization with exclusive bilateral internal thoracic arteries (BITA) is less frequently used especially in specific subsets of patients, including females. We report our experience with total arterial revascularization with exclusive BITA regardless of sex and analyze the impact of female sex on the early and midterm outcomes. Methods: Total arterial revascularization with exclusive BITA was performed with equal frequency in females (79/99, 80%) and males (392/477, 82%; P = .68) undergoing isolated CABG for 3-vessel disease. Pre, intra and postoperative data were compared between these two groups. Results: Complete revascularization was achieved in 77% of females and 72% of males (P = .08). Early mortality did not differ between the groups (6.3% versus 4.6%, P = .7). The incidence of re-sternotomy for bleeding, postoperative stroke, myocardial infarction, new onset atrial fibrillation, and hemofiltration for renal failure did not differ between the two groups. However, there were significantly more wound revision for combined superficial and deep sternal wound infection in females (26.5% versus 5.1%, P = .0001). Nevertheless, midterm survival, freedom from repeat revascularization, myocardial infarction, stroke, and major adverse cardiovascular and cerebral events at five years were very good and compared favorably between females and males. Conclusions: Our findings suggest that total arterial myocardial revascularization with exclusive internal thoracic arteries in females carries the same midterm benefits as in males. Early outcomes are comparable except for a higher incidence of wound revision for combined superficial and deep sternal wound infections in females compared to males. Benefits of bilateral internal thoracic artery grafting in females should be weighed against increased risk of early wound revision.

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