scholarly journals An evaluation of the long-term patency of the aortocoronary bypass graft anastomosed to a vascular prosthesis

2020 ◽  
Vol 58 (4) ◽  
pp. 832-838
Author(s):  
Ai Kawamura ◽  
Daisuke Yoshioka ◽  
Koichi Toda ◽  
Ryoto Sakaniwa ◽  
Shigeru Miyagawa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Vascular Prosthesis ◽  
Ascending Aorta ◽  
Graft Occlusion ◽  
Proximal Anastomosis ◽  
Left Circumflex Artery ◽  
Anastomosis Site

Abstract OBJECTIVES Although concomitant surgery for coronary artery disease (CAD) and thoracic aortic aneurysm is performed often, the long-term patency of the coronary artery bypass grafting (CABG) anastomosed to a vascular prosthesis has not been fully investigated. Here, we explored the long-term patency of the graft in comparison with the proximal anastomosis site on the native ascending aorta or vascular prosthesis. METHODS A total of 84 patients with concomitant CABG who underwent surgery for thoracic aortic aneurysm at 3 Osaka Cardiovascular Research Group institutes were retrospectively investigated for this study. The patency of 109 aortocoronary bypasses using saphenous vein grafts was evaluated with computed tomography angiography or coronary angiography, comparing the grafts anastomosed on the vascular prosthesis (group P, n = 75) to those anastomosed on the native ascending aorta (group N, n = 34). RESULTS During 45.9 ± 39.7 months follow-up, significantly worse patency of the grafts in group P was revealed when compared with those in group N (100% vs 77.6% in 12 months, 100% vs 52.7% in 36 months and 100% vs 31.6% in 57 months, log rank P < 0.001). The poor patency of the grafts was confirmed in each target lesions (left anterior descending artery: P = 0.050, right coronary artery: P = 0.045, left circumflex artery: P = 0.051) and regardless of the severities of the target coronary vessels (severe stenosis: P = 0.013, mild-to-moderate stenosis: P = 0.029). Furthermore, an analysis of graft occlusion risk factors using the univariate Cox proportional hazards model revealed that the proximal anastomosis site on the vascular prosthesis was the sole risk factor for graft occlusion (P < 0.001). CONCLUSIONS In the simultaneous surgery for CAD and thoracic aortic aneurysm, CABG design from vascular prosthesis to coronary artery should be avoided if possible, although further studies are warranted.

Vascular Disease

2016 ◽  
pp. 129-142
Author(s):  
Robert D. McBane
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Vascular Disease ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Ascending Aorta ◽  
Tobacco Exposure ◽  
Degree Relative ◽  
Men And Women ◽  
Medial Degeneration

Aneurysms of the ascending aorta are typically due to medial degeneration, whereas aneurysms of the descending thoracic aorta are primarily due to atherosclerosis. Men and women are equally affected, and the prevalence of thoracic aortic aneurysm (TAA) increases with advancing age. Overall, the incidence is approximately 1 per 10,000 individuals, and 20% of patients with TAA have at least 1 affected first-degree relative. Typical risk factors include tobacco exposure, hypertension, infection, and trauma.

scholarly journals Variations in the Left Coronary Artery

2017 ◽  
Vol 16 (1) ◽  
pp. 42-47
Author(s):  
Sultana Ruma Alam
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
Artery Bypass ◽  
Clinical Manifestations ◽  
Coronary Arteriography ◽  
Ascending Aorta ◽  
Main Stem ◽  
Aortic Sinus ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Background : There is a large spectrum of variations in the disposition of coronary arteries. Many of these variations are 'normal' and not considered as 'anomalous'1. These variations mainly occur in the Left Coronary Artery (LCA)2. While some of these are benign and have no clinical consequences, other variants can cause important clinical manifestations including sudden death of the individual3. Lack of knowledge of such variations can pose difficulties in percuteneous coronary arteriography, coronary artery bypass surgery or prosthetic valve replacement. A cadaveric study in unsuspected population can help to understand the variations that will be useful to determine the prevalence of certain variations. Thus the objective of this study was to analyze the characteristics of LCA that may be used in the diagnosis and treatment of its pathologies.Methods: The study was carried out in the Department of Anatomy, Chittagong Medical College (CMC) Chittagong over a period between Jan 2012 to Dec 2013 with ethical clearance. A detailed dissection of LCA and its branches in 50 cadaveric human hearts, fixed in 10% formalin was carried out to study normal and variant anatomy of LCA. The length of the main stem of LCA was measured by slide calipers.Results: The LCA was found to arise from the Left Posterior Aortic Sinus (LPAS) of the ascending aorta in 100% cases. The level of the ostia (Opening of coronary artery) was above the free margin of the aortic cusps in 98% cases. In all samples ostia were present below sinutubular ridge (A slight circumferential thickening separating bulbar aortic sinus and proximal ascending aorta). The length of the main stem of LCA (From origin to the point of termination into main branches) was found to range from 0.5-2 cm. The LCA showed bifurcation in 74%, trifurcation in 26% of cases. Left Anterior Descending artery (LAD) was found to terminate at the apex of the heart in 68% and at the posterior interventricular groove in 32% cases. The Left Circumflex artery (LCx) was terminated at the crux of the heart in 52%, near the crux in 44% and by crossing the crux in 4% cases. The Left Marginal Artery (LMA) which was present only in 34% cases, found to terminate nearer to the apex of the heart. 0% Left dominance of heart was observed.Conclusion: Simple attention to potential variations in the origin, number, level of ostia, length of the main stem, branching pattern, termination and distribution of LCA can greatly enhance clinical outcomes.Chatt Maa Shi Hosp Med Coll J; Vol.16 (1); Jan 2017; Page 42-47

Comparison of immediate and long-term results of stenting and open surgery for thoracic aortic aneurysm

2017 ◽  
Vol 10 (2) ◽  
pp. 52 ◽  
Author(s):  
Yu. V. Belov ◽  
S. A. Abugov ◽  
R. S. Polyakov ◽  
E. R. Charchyan ◽  
M. V. Puretskiy ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Open Surgery ◽  
Thoracic Aortic Aneurysm ◽  
Long Term Results

scholarly journals Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Sabry Omar ◽  
Tyler Moore ◽  
Drew Payne ◽  
Parastoo Momeni ◽  
Zachary Mulkey ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Thoracic Aortic Aneurysm ◽  
Ascending Aorta ◽  
Screening Methods ◽  
Significant Past Medical History ◽  
Iliac Arteries ◽  
Aortic Aneurysm And Dissection ◽  
History Of ◽  
Chest X Ray

We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

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