Branched internal mammary conduit permits non-sequenced total arterial revascularization

2020 ◽  
pp. 021849232097595
Author(s):  
Andrew CW Baldwin ◽  
George Tolis
Keyword(s):  
Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Free Graft ◽  
Total Arterial Revascularization ◽  
Surgical Complexity ◽  
Internal Mammary ◽  
Recent Trends ◽  
The Right ◽  
Overall Mortality

Recent trends in cardiac surgery have encouraged total arterial coronary revascularization, citing advantages in long-term patency and overall mortality. Often relying on sequenced, composite, and free-graft strategies, total arterial coronary revascularization is limited by conduit availability and surgical complexity. We present the use of bilateral internal mammary artery grafts to achieve nonsequential 3-vessel total arterial coronary revascularization using the preserved distal bifurcation of the right internal mammary artery. Utilization of distal internal mammary artery branches should be considered a viable strategy in select patients and can broaden the opportunities for total arterial coronary revascularization in patients with multivessel coronary disease.

Bovine internal mammary artery as a conduit for coronary revascularization: Long-term results

1993 ◽  
Vol 55 (1) ◽  
pp. 120-122 ◽  
Author(s):  
Ian M. Mitchell ◽  
A. Rashid Essop ◽  
Peter J. Scott ◽  
Paul G. Martin ◽  
Nirmal K. Gupta ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Long Term Results ◽  
Internal Mammary

The GraftConnector Experience

Swiss Surgery ◽  
2001 ◽  
Vol 7 (5) ◽  
pp. 209-210 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Jan Otto Solem ◽  
Boumzebra ◽  
Antonio Mucciolo ◽  
Xavier Mueller ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Long Term Results ◽  
Sheep Model ◽  
Adult Sheep ◽  
Internal Mammary ◽  
The Mean ◽  
The Right

Background: A device to perform sutureless end-to-side coronary artery anastomosis has been developed by means of stent technology (GraftConnector). The present study assesses the long-term quality of the GraftConnector anastomosis in a sheep model. Methods: In 8 adult sheep, 40-55kg in weight, through left anterior thoracotomy, the right internal mammary artery (RIMA) was prepared and connected to the left anterior descending artery (LAD) by means of GraftConnector, on beating heart, without using any stabiliser. Ticlopidine 250mg/day for anticoagulation for 4 weeks and Aspirin 100mg/day for 6 months were given. The animals were sacrificed after 6 months and histological examination of anastomoses was carried out after slicing with the connector in situ for morphological analysis. Results: All animals survived at 6 months. All anastomoses were patent and mean luminal width at histology was 1.8 0.2mm; mean myointima hyperplasia thickness was 0.21 0.1mm. Conclusions: Long-term results demonstrate that OPCABGs performed with GraftConnector had 100% patency rate. The mean anastomotic luminal width corresponds to mean LAD's adult sheep diameter. We may speculate that myointima hyperplasia occurred as a result of local device oversizing.

Abstract 15732: Impact of Bilateral Mammary Artery Grafting for Coronary Revascularization in the Obese Population, a Retrospective Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emmeline Ruka ◽  
François Dagenais ◽  
Siamak Mohammadi ◽  
Vincent Chauvette ◽  
Pierre Voisine
Keyword(s):  
Survival Benefit ◽  
Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Obese Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Obese Population ◽  
Internal Mammary

Context: The prevalence of obesity has increased over the last decade. Although bilateral internal mammary artery (BIMA) grafting for coronary revascularization is associated with better survival in the general population, it is also a risk factor for deep sternal wound infection (DSWI), a complication more frequently seen in the obese population. The aim of this study is to determine the short and long-term outcomes of the use of BIMA in obese patients undergoing cardiac surgery, assessing the impact on survival and the incidence of DSWI. Methodology: This is a single center retrospective cohort study with prospectively collected data. We included obese patients (BMI ≥ 30 kg/m2) undergoing coronary artery bypass grafting (CABG) between April 1991 and April 2014 in our institution. Propensity score matching was conducted for the entire population studied. Results: Results showed that 5608 obese patients underwent CABG during the study period. After propensity scoring, 494 patients receiving BIMA revascularization were matched to 5089 patients receiving single internal mammary artery (SIMA) revascularization. All pre-operative characteristics were comparable except for a higher prevalence of heart failure in the SIMA group. In-hospital post-operative mortality in the two groups was comparable (1.0% BIMA vs 1.8% SIMA, p=0.86). In-hospital DSWI was also comparable (1.2% BIMA vs 1.0% SIMA, p=0.63). However total DSWI (including post-discharge DSWI, median time 19 days) was significantly higher in the BIMA group compared to the SIMA group (3.6% vs 2.2%; p<0.0001). Over a median follow-up of 7.2 years (mean follow-up 7.7 ± 4.2 years), there was no observed long-term survival advantage in the BIMA vs the SIMA group (p=0.22). Conclusion: Using BIMA instead of SIMA increases the risk of DSWI in obese patients. The use of BIMA is not associated with better survival compared to the use of SIMA in this population. These results suggest that the increased short-term risk of post-operative infection associated with BIMA revascularization is not offset by a long-term survival benefit. Given the increased risk of DSWI and absence of mid- to long-term survival benefit, caution should be exerted when selecting the use of BIMA grafting in the obese population.

Right Gastroepiploic Artery in Myocardial Revascularization: Portuguese Experience

1995 ◽  
Vol 3 (2) ◽  
pp. 71-74
Author(s):  
José Roquette ◽  
Jorge Ouininha ◽  
Nelson Castelão ◽  
Filipe Robalo ◽  
Duarte Serra e Melo ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Myocardial Revascularization ◽  
Gastroepiploic Artery ◽  
Inferior Wall ◽  
Perioperative Myocardial Infarction ◽  
Arterial Revascularization ◽  
Right Gastroepiploic Artery ◽  
Internal Mammary ◽  
The Right

Excellent results obtained with the use of the internal mammary artery in myocardial revascularization led us to complement its use with other arterial conduits, and the right gastroepiploic artery (RGEA) emerged as a valid alternative, allowing the expansion of total arterial revascularization. From July 1988 until September 1994 we utilized the RGEA in 101 patients with ages between 30 and 71 years (mean 54 9.43). The RGEA was used to bypass the posterior descending artery in 90 patients and for the marginal branches of the circumflex in 11. Exclusive arterial revascularization was possible in 92% of the cases with a mean of 2.7 bypasses per patient. There were 4 (4%) cases of death, and 3 instances of perioperative myocardial infarction. Angiographic control of the RGEA performed in 46 patients showed a patency of 87%. In conclusion, the RGEA was predominantly used to revascularize the inferior wall of the myocardium as a complement to the internal mammary artery. Its use occurred without significant morbidity and mortality, and postoperative angiographic visualization of these arterial conduits allowed us to expect good mid-and long-term patency.

scholarly journals Does Use of Bilateral Internal Mammary Artery Grafting Reduce Long-Term Risk of Repeat Coronary Revascularization?

Circulation ◽  
2017 ◽  
Vol 136 (18) ◽  
pp. 1676-1685 ◽  
Author(s):  
Alexander Iribarne ◽  
Joseph D. Schmoker ◽  
David J. Malenka ◽  
Bruce J. Leavitt ◽  
Jock N. McCullough ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Internal Mammary
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