scholarly journals Early Patency Evaluation of New Distal Anastomotic Device in Internal Mammary Artery Grafts Using Computed Tomography Angiography

2010 ◽  
Vol 5 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Husam H. Balkhy ◽  
L. Samuel Wann ◽  
Susan Arnsdorf
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Internal Mammary

Introduction Traditional coronary artery bypass grafting is performed using a hand sewn technique. The C-Port xA and Flex A anastomotic stapling devices (Cardica Inc., Redwood City, CA) were cleared by the Food and Drug Administration for use in distal coronary anastomoses in November 2006 and April 2007, respectively. They provide the ability to create a compliant, consistently reproducible, and automated anastomosis. Multidetector computed tomography (CT) has been shown to be effective in evaluating coronary artery bypass graft patency. Methods The first 24 patients to undergo internal mammary artery (IMA) anastomosis using the automated device in our practice were included in the study. Twenty-five IMA grafts (24 left IMA and 1 right IMA) were created using the C-Port xA or Flex A anastomotic device as part of multivessel off-pump coronary revascularization by sternotomy. Graft patency was evaluated at 30 days in the first 10 grafts and at 90 days in the next 15 grafts using multidetector (64 slice) CT. Results There were no device failures. There were no perioperative strokes, myocardial infarctions, or deaths. All 10 IMA grafts evaluated at 30 days were patent using multidetector CT. One of the 15 IMA grafts studied at 90 days was occluded using multidetector computed tomography. Conclusions The C-Port xA and Flex A distal anastomotic devices provided a safe and effective means to create a left IMA-left anterior descending artery anastomoses in coronary bypass surgery with excellent short to midterm patency in this early experience. Long-term follow-up is warranted. These findings will have important implications for future sternal sparing coronary bypass surgery.

Sixteen-Slice Multidetector Computed Tomography for Graft Patency Evaluation After Coronary Artery Bypass Surgery

2008 ◽  
Vol 23 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Miguel Sousa Uva ◽  
Fernando Matias ◽  
Armindo Mesquita ◽  
Rogério Costa ◽  
José Baú ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Graft Patency

Survival benefit from a second arterial conduit to the circumflex circulation persists in elderly after coronary artery bypass surgery

2021 ◽  
pp. 021849232199707
Author(s):  
Suvitesh Luthra ◽  
Miguel M Leiva-Juárez ◽  
Pietro G Malvindi ◽  
John S Billing ◽  
Sunil K Ohri
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Survival Benefit ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Arterial Graft ◽  
Arterial Conduit ◽  
Internal Mammary

Background This retrospective propensity matched study investigated the impact of age on the survival benefit from a second arterial conduit to the left-sided circulation. Methods Data for isolated coronary artery bypass surgery were collected from October 2004 to March 2014. All patients with an internal mammary artery graft to left anterior descending artery and additional arterial or venous graft to the circumflex circulation were included. Propensity matching was used to balance co-variates and generate odds of death for each observation. Odds ratios (venous vs. arterial) were charted against age. Results The in-hospital mortality rate was 1.12% (arterial) vs. 1.24% (venous) (p = 0.77). The overall 10-year survival was 74.6% (venous) vs. 82.6% (arterial) (p = 0.001). A total of 1226 patients were successfully matched to the venous or arterial (second conduit to circumflex territory after left internal mammary artery to left anterior descending artery) cohorts. Odds ratio for death (venous to arterial) showed a linear decremental overall survival benefit for the second arterial graft to circumflex circulation with increasing age. Conclusions The survival benefit of a second arterial graft persists through all age groups with a gradual decline with increasing age over the decades. Elderly patients should not be denied a second arterial graft to the circumflex circulation based on age criterion alone.

Robotically Assisted Coronary Endarterectomy

2011 ◽  
Vol 6 (6) ◽  
pp. 391-394 ◽  
Author(s):  
Murtaza Y. Dawood ◽  
Eric J. Lehr ◽  
Andreas de Biasi ◽  
Reyaz Haque ◽  
Alina Grigore ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Balloon Catheter ◽  
Coronary Endarterectomy ◽  
Internal Mammary ◽  
The Right

Robotic assistance has enabled coronary artery bypass surgery to be performed safely in a completely endoscopic fashion, but diffusely diseased target vessels may pose a technical challenge. We present a case in which coronary endarterectomy was performed on the left anterior descending coronary artery during a two-vessel totally endoscopic coronary artery bypass procedure. A 52-year-old woman presented with intermittent substernal pain. Preoperative studies showed diffuse disease in the left coronary artery system. Bilateral internal mammary arteries were harvested robotically using a skeletonized technique in a completely endoscopic fashion. Cardiopulmonary bypass was achieved via peripheral cannulation, and the heart was arrested with intermittent cold antegrade hyperkalemic blood cardioplegia delivered via an ascending aortic occlusion balloon catheter. The first obtuse marginal anastomosis was performed. The left anterior descending coronary artery was diffusely diseased and heavily calcified. An end-to-side anastomosis was attempted to the right internal mammary artery with unsatisfactory results. A localized coronary endarterectomy was performed, and an extended anastomosis was completed using the right internal mammary artery. The patient recovered uneventfully and was discharged home on postoperative day 6. Diffuse coronary artery disease was once thought to be a prohibitive challenge for minimally invasive coronary bypass procedures. This case demonstrates that local coronary endarterectomy is feasible and safe in robotic totally endoscopic coronary artery bypass surgery.

Does the use of bilateral internal mammary artery grafts impact survival of veterans undergoing coronary artery bypass surgery?

2008 ◽  
Vol 196 (5) ◽  
pp. 726-731 ◽  
Author(s):  
Faisal G. Bakaeen ◽  
Danny Chu ◽  
Amandeep S. Dhaliwal ◽  
Biykem Bozkurt ◽  
Xing Li Wang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Internal Mammary

174 Semi-Skeletonized Versus Pedicled Internal Mammary Artery Harvesting: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A M A Shafi ◽  
S Mellor ◽  
S Iddawela ◽  
L Brown ◽  
A Harky
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Preparation Technique ◽  
Operative Outcomes ◽  
Harvesting Technique ◽  
Internal Mammary

Abstract Objectives To compare semi-skeletonized with pedicled harvesting technique of the internal mammary artery for coronary artery bypass surgery. Method A comprehensive literature search was performed on PubMed, Cochrane database, Embase, Google Scholar and Ovid identifying articles that compared semi-skeletonised to pedicled internal mammary artery in the use of coronary artery bypass surgery. Databases were evaluated and assessed from inception to July 2020. Results Only five studies fulfilled the criteria for this review. There was no reported incidence of sternal wound infection, myocardial infarction, or mortality. The length of the IMA graft was longer in the semi-skeletonized group compared to the pedicled group, 16.06cm versus 14.63cm respectively (p < 0.001). The intraoperative diastolic flow was significantly greater in the semi-skeletonized grafts than in the pedicled grafts during (p = 0.003) and after (p = 0.005) cardiopulmonary bypass. The incidence of pleural effusion (pedicled, 52.6%; semi-skeletonized, 23.6%; p = 0.002) and atelectasis (pedicled, 42.1%; semi-skeletonized, 20.0%, p = 0.015) were significantly higher in pedicled group. Post-operative chest tube drainage was significantly higher in the pedicled group (608 ± 58 mL compared to 470 ± 48 mL; p = 0.027). Additionally, FEV1 was significantly decreased in the pedicled group 6 days after surgery (pedicled:76.0% ± 1.6%; semi-skeletonized: 83.2% ± 1.6%; p = 0.020). Conclusions These results demonstrate that the semi-skeletonized preparation technique is associated with satisfactory outcomes during harvesting the internal mammary artery. Yet, due to limited numbers of studies, there is need for larger comparative studies to assess post-operative outcomes with a longer period of follow up.

Respiratory Complications After Coronary Artery Bypass Surgery With Unilateral or Bilateral Internal Mammary Artery Grafting

CHEST Journal ◽  
1998 ◽  
Vol 113 (5) ◽  
pp. 1285-1289 ◽  
Author(s):  
Maria Daganou ◽  
Ioanna Dimopoulou ◽  
Nickolaos Michalopoulos ◽  
Konstantinos Papadopoulos ◽  
Anna Karakatsani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Respiratory Complications ◽  
Internal Mammary

Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery

2019 ◽  
Vol 14 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Hiroto Kitahara ◽  
Sarah Nisivaco ◽  
Husam H. Balkhy
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Robotic Assisted

Objective With advances in robotic instrumentation and technology, both robotically assisted minimally invasive direct coronary artery bypass (RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been widely used over the past 20 years. Graft patency is the most important outcome in coronary bypass surgery and is associated with long-term prognosis. In this article we reviewed all experts’ studies in the field of robotic assisted coronary artery bypass and investigated graft patency in patients who underwent RMIDCAB or TECAB. Methods We performed a literature search in PubMed from 1999 to 2018 using the terms “Robotic” and “Coronary bypass” and/or “Minimally invasive” and/or “Totally endoscopic.” Of the articles found, studies investigating graft patency were specifically selected. Results In 33 articles, a total of 4,000 patients underwent robotic assisted coronary artery bypass surgery either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft patency was assessed by invasive angiography or computed tomographic angiography in all studies. The mean graft patency at early (<1 month), midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%, and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively. Conclusions The graft patency of robotic assisted coronary artery bypass was equivalent to reported outcomes of the conventional approach. These results should encourage the adoption of robotic approaches in coronary bypass surgery.

Sign in / Sign up

Export Citation Format

Share Document