Use of the Right Mammary Artery for Coronary Bypass

1987 ◽  
Vol 21 (5) ◽  
pp. 301-304
Author(s):  
Ram N. Singh ◽  
Paul C. Taylor
Keyword(s):  
Coronary Bypass ◽  
The Right

MINI OPCAB Operation: Surgical Technique

2021 ◽  
Author(s):  
Federico Benetti ◽  
Natalia Scialacomo ◽  
Gustavo Mazzolino
Keyword(s):  
Surgical Technique ◽  
Large Scale ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Revascularization ◽  
Pump Coronary Artery Bypass ◽  
The Right

Introduction: We describe how to perform left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) artery, the so-called MINI Off-pump Coronary Artery Bypass (MINI OPCAB). Materials and Methods: We included patients with a demonstrated predominant ischemia related to the LAD territory. Of 70 patients who were operated upon at the Benetti Foundation, 10 received hybrid revascularization. Surgical Technique: The patient is prepared as for a standard coronary bypass operation through sternotomy. The sternum is opened to the 3rd or 4th intercostal space depending on the anatomy, and a retractor is put in place. The left mammary artery is generally dissected to about 8 cm and isolated without the veins. Importantly, the angle of the superior part, where the mammary artery is attached to the sternum, needs to be below 20% to avoid any potential kinking. The pericardium is cleaned to identify the area of the pulmonary artery. The pericardium is opened to the apex and towards the right to around 5 to 6 cm initially. In most cases, the area of the LAD can be seen and the potential area of the anastomosis is defined. The patient is heparinized and the LAD is occluded with 5-0 Proline. A mechanical stabilizer is put in place and the anastomosis is performed. When the bypass is finished, and before sutures are tied, the stitches of 5-0 polypropylene around the artery are released, along with the clamp of the mammary artery; the anastomosis is then tied. The mechanical stabilizer is removed, the stitches of the pericardium are released and the flow of the graft is measured, while ensuring that there is no kinking. If the flow and Pulsatility and Resistance (PR) are acceptable, the mammary is fixed with 2 stitches of 7-0 polypropylene on both sides around 1 cm from the anastomosis. The heparin is reverted with protamine and a drain is put in place, while taking care to avoid any chance of touching the mammary artery or the anastomosis. The sternum is closed with 1 or 2 wires. Results: Operative mortality in this series was 0%; one patient was converted to sternotomy off-pump (1.4%). None of the grafts were revised after measurement with a Medistim system (Medistim ASA, Oslo, Norway). Fifty five patients (79%) were extubated in the operating room The average hospitalization stay was 60 hours (SD 17, 95% CI). Sixteen patients who underwent the LIMA-to-LAD procedure were restudied, with 100% patency. At 144 months, 82% of the patients were alive and 68% were asymptomatic. Conclusion: Additional clinical experience is required to be able to reproduce this operation on a large scale and expand the MINI OPCAB operation in hybrid revascularization.

Successful endovascular extraction of newer generation Angio-Seal collagen plug and anchor after acute embolization

Vascular ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 214-217 ◽  
Author(s):  
Nidal Abi Rafeh ◽  
Faisal B Saiful ◽  
Georges Khoueiry ◽  
Mohammad Zgheib ◽  
Salman Arain
Keyword(s):  
Coronary Bypass ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Closure Device ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Vascular Laboratory ◽  
History Of ◽  
Drug Eluting ◽  
The Right

A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Angio-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.

Increased expression of endothelin-converting enzyme-1 in failing human myocardium

2002 ◽  
Vol 103 (s2002) ◽  
pp. 237S-240S ◽  
Author(s):  
Henning MORAWIETZ ◽  
Winfried GOETTSCH ◽  
Marten SZIBOR ◽  
Matthias BARTON ◽  
Sidney SHAW ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Coronary Bypass ◽  
Heart Association ◽  
Right Atrial ◽  
Converting Enzyme ◽  
Atrial Myocardium ◽  
Endothelin Converting Enzyme ◽  
The Right

Endothelin-1 (ET-1) is considered to be involved in the development and progression of heart failure. Therefore, we analysed the expression of endothelin-converting enzyme-1 (ECE-1), endothelin receptors A (ETA) and B (ETB) mRNAs by standard-calibrated, competitive reverse transcriptase-PCR using an internal-deleted in vitro-transcribed cRNA standard. ET-1 peptide levels were measured using isoform-specific rabbit antibodies against synthetic ET-1. mRNA and protein expression was determined in the right atrial myocardium of New York Heart Association class I patients and class IV patients undergoing aorto-coronary bypass surgery. ECE-1 mRNA was upregulated in failing atrial myocardium. Furthermore, ET-1 peptide levels were increased in failing atrial myocardium. Atrial ETA mRNA expression was not changed, while ETB mRNA was downregulated in the failing atrial myocardium. Our results support an upregulation of ET-1 synthesis by induction of ECE-1 in failing atrial myocardium. Pharmacological inhibition of augmented ECE-1 expression might provide a new therapeutic perspective in the treatment of heart failure.

scholarly journals P1496 Congenital anomalous origin of the left coronary system

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Ahmad ◽  
I Ahmed ◽  
R Jibran ◽  
C Raimondo
Keyword(s):  
Coronary Angiography ◽  
Systolic Function ◽  
Coronary Vessels ◽  
Coronary Bypass ◽  
Anomalous Origin ◽  
History Of ◽  
Coronary Cusp ◽  
Normal Ecgs ◽  
The Right ◽  
Right Coronary Cusp

Abstract A 62 year old gentleman presented with a history of recurrent central chest pains radiating to the left arm and jaw lasting up to 15-20 minutes and relieved with GTN. He had numerous admissions to hospital over a period of three years with negative Troponins and normal ECGs. There were several cardiovascular risk factors including obesity, diabetes, hypertension and dyslipidaemia. He also had a family history of ischaemic heart disease, with his mother and brother having heart attacks in their 60s. He was referred for outpatient investigations on multiple occasions but did not attend. This lead to a delay in a formal diagnosis until we eventually convinced him to undergo invasive diagnostic coronary angiography in June 2018. Prior to this, an Echocardiogram was done and showed reasonably preserved cardiac systolic function. Coronary angiography demonstrated unique anatomical distribution of the three main coronary vessels, with an anomalous origin of the left main system (LMS) and left sided arteries arising from the right coronary cusp. The right coronary artery stemmed from its natural position and was the dominant vessel. Hence, all the coronary arteries arose from the same cusp. The LMS was anomalous and hypoplastic; an exceedingly rare occurrence of less than 0.03%. These unusual findings were then confirmed on CT Coronary Angiogram. Although a surgical opinion was sought, the decision was a non-operative approach in view of no significant obstructive lesions and given the technical difficulties of undertaking coronary bypass. Viability imaging and ischaemia testing were then pursued with nuclear modalities. Ultimately, it was proven that the lesions did not show any significant reversible ischaemia and so a continued aggressive secondary prevention strategy was adopted. The patient is stable and doing well on optimal medical therapy. Abstract P1496 Figure. LMS Arising From Right Coronary Cusp

Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns

2022 ◽  
Vol 18 ◽  
Author(s):  
Alfred Stanley ◽  
Constantine Athanasuleas
Keyword(s):  
Cardiac Surgery ◽  
Right Ventricular ◽  
Systolic Function ◽  
Coronary Bypass ◽  
Valve Repair ◽  
Off Pump ◽  
Pump Valve ◽  
The Right ◽  
Mini Thoracotomy ◽  
Septal Motion

Abstract: Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent. Global RV systolic function, stroke volume and ejection fraction remain normal after uncomplicated CS, but regional contractile patterns are altered. There is a decrease in longitudinal shortening but an increase in transverse shortening in the endocardial and epicardial right ventricular muscle fibers, respectively. PSM is a secondary event as there is no loss of septal perfusion or thickening. The increased RV transverse shortening (free wall to septal fibers) may modify septal movement resulting in PSM that compensates for the reduced RV longitudinal shortening, thus preserving normal global right ventricular function.

A method for stereoscopic strain analysis of the right ventricle by digital image correlation during coronary bypass surgery: short communication

2015 ◽  
Vol 60 (3) ◽  
Author(s):  
Nikolas Mirow ◽  
Mikko Hokka ◽  
Horst Nagel ◽  
Marc Irqsusi ◽  
Rainer G. Moosdorf ◽  
...  
Keyword(s):  
Digital Image ◽  
Short Communication ◽  
Strain Analysis ◽  
Coronary Bypass ◽  
Image Correlation ◽  
Non Invasive ◽  
Right Ventricular Strain ◽  
Challenging Tasks ◽  
The Right ◽  
Severe Heart Disease

AbstractPerioperative cardiosurgical management of volume therapy remains one of the challenging tasks in cases of patients with severe heart disease. Early detection of congestive cardiac failure prevents subsequent low output and worse outcome. An effective method for controlling extracorporeal circulation is created by developing a non-invasive intraoperative method for right ventricular strain analysis through digital image contrast correlation.

Right Internal Mammary Artery Use in 140 Robotic Totally Endoscopic Coronary Bypass Cases: Toward Multiarterial Grafting

2017 ◽  
Vol 12 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Husam H. Balkhy ◽  
Sandeep Nathan ◽  
Susan E. Arnsdorf ◽  
Dorothy J. Krienbring
Keyword(s):  
Internal Mammary Artery ◽  
Length Of Hospital Stay ◽  
Coronary Bypass ◽  
Beating Heart ◽  
Arterial Graft ◽  
Flow Measurements ◽  
Artery Graft ◽  
Internal Mammary Artery Graft ◽  
Internal Mammary ◽  
The Right

Objective Benefits of adding a second arterial graft in coronary bypass are well documented. In patients requiring mulitvessel grafting robotic totally endoscopic coronary bypass (TECAB) has allowed for routine harvesting and use of the right internal mammary artery (RIMA). We retrospectively reviewed the technical considerations and target choice in 140 cases of beating heart TECAB where a RIMA graft was used. Methods In 2008, we introduced beating heart TECAB with anastomotic connectors into our practice, first with single IMA and then with bilateral internal mammary artery. A robotic stabilizer was used not only to facilitate exposure of the coronary targets but also to aid the RIMA harvest using a skeletonized approach. Flow measurements were obtained routinely. We reviewed the technical aspects, target choice, and intraoperative flows in our TECAB patients who underwent grafting with RIMA grafts. Results From February 2008 to January 2015, a total of 404 patients underwent beating heart TECAB with anastomotic connectors, of which 194 (48%) were mulitvessel procedures. One hundred forty patients (35%) had a RIMA graft and constitute the patient population for this review. One hundred thirty-one RIMA grafts were harvested via left-sided ports and grafted to left coronary targets, and nine RIMA grafts were harvested via right-sided ports and grafted to the right coronary artery. Flow was greater than 25 mL/min (pulsatility index < 2) in 95% of grafts. Perioperative mortality was 0.7% and mean ± standard deviation length of hospital stay was 3.1(1.5) days. The RIMA was used as an in situ graft in 124 cases (84%) and as a free T-graft in 24 cases (16%) cases. Right internal mammary artery graft use in all TECABS increased from 23% in the first 5 years to 53% in the last 2 years. Conclusions Robotic TECAB allows the routine harvesting and use of the RIMA graft in a safe and reproducible manner. Skeletonization and sternal sparing allow the RIMA to reach various coronary targets. Further studies are needed for this approach to impact the adaption of multiarterial grafting.

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