scholarly journals Total arterial myocardial revascularization using bilateral internal mammary arteries and the role of postoperative sternal stabilization to reduce wound infections in a large cohort study

2019 ◽  
Vol 29 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Marc Albert ◽  
Ragi Nagib ◽  
Adrian Ursulescu ◽  
Ulrich F W Franke
Keyword(s):  
Retrospective Study ◽  
Wound Infection ◽  
Internal Mammary Artery ◽  
Wound Closure ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Wound Infections ◽  
Term Survival ◽  
Mammary Arteries ◽  
Internal Mammary

Abstract OBJECTIVES Total arterial myocardial revascularization using bilateral internal mammary arteries shows improved results for mortality, long-term survival and superior graft patency. It has become the standard technique according to recent guidelines. However, these patients may have an increased risk of developing sternal wound infections, especially obese patients or those with diabetes. One reason for the wound complications may be early sternum instability. This situation could be avoided by using a thorax support vest (e.g. Posthorax® vest). This retrospective study compared the wound complications after bilateral internal mammary artery grafting including the use of a Posthorax vest. METHODS Between April 2015 and May 2017, 1613 patients received total arterial myocardial revascularization using bilateral internal mammary artery via a median sternotomy. The Posthorax support vest was used from the second postoperative day. We compared those patients with 1667 patients operated on via the same access in the preceding 26 months. The end points were the incidence of wound infections, when the wound infection occurred and how many wound revisions were needed until wound closure. RESULTS The demographic data of both groups were similar. A significant advantage for the use of a thorax support vest could be seen regarding the incidence of wound infections (P = 0.036) and the length of hospital stay when a wound complication did occur (P = 0.018). CONCLUSIONS As seen in this retrospective study, the early perioperative use of a thorax stabilization vest, such as the Posthorax vest, can reduce the incidence of sternal wound complications significantly. Furthermore, when a wound infection occurred, and the patient returned to the hospital for wound revision, patients who were given the Posthorax vest postoperatively had a significantly shorter length of stay until wound closure.

scholarly journals Sternal healing after bilateral internal mammary arteries use for Coronary artery bypass grafting in diabetic Patients; short-term results

2020 ◽  
Author(s):  
Islam Moheb Ibrahim ◽  
Ahmed Labib Dokhan ◽  
Yahia Balbaa Anwar Balbaa ◽  
Ibrahim Mohammed Khalil ◽  
Mohammed Ahmed El-Hag-Aly
Keyword(s):  
Wound Infection ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Diabetic Patients ◽  
Bypass Grafting ◽  
Risk Of Infection ◽  
Mammary Arteries ◽  
Internal Mammary ◽  
Group A ◽  
Group B

Background:  Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high.   Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended.

Early Results with Bilateral and Single Internal Mammary Artery Grafts. Are They Different?

1997 ◽  
Vol 5 (1) ◽  
pp. 8-14
Author(s):  
Naresh Trehan ◽  
Surendra Nath Khanna ◽  
Vijay Mohan Kohli ◽  
Anil Karlekar ◽  
Yugal Mishra ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Perioperative Complications ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Vein Grafts ◽  
Early Results ◽  
Total Hospital Stay ◽  
Internal Mammary

Between June 1991 and June 1996, 391 patients underwent isolated myocardial revascularization using bilateral internal mammary artery. Three hundred and sixty-five of these patients could be matched retrospectively on the basis of preoperative characteristics with 365 patients operated on during same period who had left internal mammary artery as a single or sequential graft with additional vein grafts. The cardiopulmonary bypass times and aortic cross-clamp times were similar in both groups. There were no statistically significant differences in the two groups in terms of operative mortality (0.55% versus 0.82%), perioperative myocardial infarction (2.46% versus 2.19%), low cardiac output (1.64% versus 1.09%), reexplorations (1.10% versus 1.92%), wound complications (1.10% versus 2.46%), length of stay in the intensive care unit, and total hospital stay. The incidence of respiratory, central nervous system, and renal complications showed no difference between the two groups. Logistic regression analysis showed that the number of internal mammary artery grafts was not a predictor for perioperative complications. If better long-term event-free survival is associated with the use of bilateral internal mammary artery, it should be used wherever possible.

scholarly journals Myocardial revascularization by internal mammary artery implant procedures

1967 ◽  
Vol 54 (3) ◽  
pp. 359-370 ◽  
Author(s):  
Rene G. Favaloro ◽  
Donald B. Effler ◽  
Laurence K. Groves ◽  
F. Mason Sones ◽  
David J. G. Fergusson
Keyword(s):  
Internal Mammary Artery ◽  
Myocardial Revascularization ◽  
Internal Mammary

Inverted internal mammary artery for myocardial revascularization

1991 ◽  
Vol 51 (3) ◽  
pp. 524-525
Author(s):  
Ugolino Livi ◽  
Uberto Bortolotti ◽  
Vincenzo Gallucci
Keyword(s):  
Internal Mammary Artery ◽  
Myocardial Revascularization ◽  
Internal Mammary

Heparin promotes the formation of extracardiac to coronary anastomoses in a canine model

1991 ◽  
Vol 260 (5) ◽  
pp. H1625-H1634 ◽  
Author(s):  
E. F. Unger ◽  
C. D. Sheffield ◽  
S. E. Epstein
Keyword(s):  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Myocardial Revascularization ◽  
Canine Model ◽  
Regional Myocardial Blood Flow ◽  
Collateral Flow ◽  
Internal Mammary ◽  
Saline Vehicle ◽  
Regional Myocardial Blood

We developed a canine model for the in vivo utilization of angiogenesis factors to promote revascularization of a collateral-dependent area of the heart and assessed the potential of heparin in this preparation. Ameroids were placed on the proximal left anterior descending coronary artery (LAD) of 29 dogs, and the left internal mammary artery (IMA) was implanted in an intramyocardial tunnel in proximity to the LAD. A tube positioned in the distal IMA provided a continuous retrograde infusion directly into the vessel from an implanted pump. Heparin (15 or 150 U/h) or saline vehicle was infused. After 8 wk, regional myocardial blood flow was assessed in the anesthetized state during adenosine-induced vasodilatation, before and during occlusion of the IMA. The IMA provided a greater proportion of maximal collateral flow in heparin-treated dogs (22 +/- 5%, n = 17) than in saline-treated dogs (9 +/- 2%, n = 12, P less than 0.05). Thus continuous infusion of heparin promotes the formation of collaterals between the extracardiac artery and the myocardial circulation, establishing the feasibility of targeting angiogenic agents for myocardial revascularization.

Left Internal Mammary Artery Graft Retransplantation from the Recipient to the Donor Heart: A Case Report

2000 ◽  
Vol 10 (1) ◽  
pp. 18-20
Author(s):  
Andras Kollar ◽  
Terri Donaldson ◽  
Elaine Greer ◽  
Renee Howser ◽  
Stacy F. Davis ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Donor Heart ◽  
Artery Graft ◽  
Internal Mammary Artery Graft ◽  
Internal Mammary ◽  
History Of

A case of heart transplantation with concomitant coronary artery bypass graft is reported. The patient was an alternate transplant list candidate with a history of bilateral below-knee amputation and 2 previous myocardial revascularization procedures. The previously used and patent left internal mammary artery graft was successfully removed and retransplanted from the recipient to the donor heart.

scholarly journals Intraoperative Validation of Left Internal Mammary Artery Graft by Flourescence Imaging Technique

2018 ◽  
Vol 10 (2) ◽  
pp. 145-149
Author(s):  
AM Asif Rahim ◽  
MAH Pervez ◽  
MG Kibria ◽  
MSH Talukder ◽  
A Zaman ◽  
...  
Keyword(s):  
Gold Standard ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Graft Patency ◽  
Conventional Angiography ◽  
Mortality And Morbidity ◽  
Internal Mammary ◽  
Operative Assessment

Background: In coronary artery bypass surgery (CABG) left internal mammary artery (LIMA) is considered gold standard conduit of choice for myocardial revascularization. Graft failure following CABG reduces cardiac mortality and morbidity both in short and long term. Although conventional angiography is gold standard for assessing graft patency but rarely available in same operating room. So intraoperative florescence imaging could be an efficient and reliable method of assessing the patency of graft.Methods: This study was conducted between July 2013 to June 2014 in the Department of Cardiac Surgery of National Institute of Cardiovascular Diseases (NICVD). Thirty six LIMA grafts were assessed by using IFI system .ICG administered through CVP line and imaging acquired during pass of the ICG through field of view graft flow. Quality of anastomosis was intra operatively to validate graft.Results: Mean age of study population was 54±8.38 years. Per operative assessment of LIMA to left anterior descending artery revealed 32 (88.8%) patent anastomosis, narrowing of anastomosis was found in 2 (5.55% ) patients.Conclusion: Intraoperative fluorescence imaging is an effective and inexpensive way to validate patency of LIMA graft.Cardiovasc. j. 2018; 10(2): 145-149

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