Coronary Revascularization in Children at a Mexican Cardiac Center: Thirteen-Year Outcomes

2017 ◽  
Vol 8 (5) ◽  
pp. 600-604 ◽  
Author(s):  
Samuel E. Ramírez-Marroquín ◽  
Alejandra Iturriaga-Hernández ◽  
Juan Calderón-Colmenero ◽  
Antonio Benita-Bordes ◽  
Jorge L. Cervantes-Salazar
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Right Coronary Artery ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Diagnostic Study ◽  
Bilateral Internal Thoracic Artery ◽  
The Right

Background: The indications for pediatric coronary revascularization are diverse. There are a large proportion of patients with sequelae of severe inflammatory diseases such as Kawasaki disease, and other less common causes. Methods: Retrospective review of ten pediatric patients undergoing coronary artery bypass surgery from January 2004 to December 2016. Results: Ten children and adolescents ranging in age from 2 to 17 (median, 6) years at operation were followed up for as long as 13 years with a median follow-up of 2 years. The surgical indications include ischemia symptoms and/or coronary stenosis angiographically documented. Diagnoses include Kawasaki disease, anomalous origin of the left coronary artery from the pulmonary artery, and iatrogenic lesion of the right coronary artery. All the surgical procedures were performed with cardiopulmonary bypass with crystalloid cardioplegic arrest. The number of distal anastomoses was 1.6 per patient, and the left internal thoracic artery was used in one patient, the right internal thoracic artery in four patients, bilateral internal thoracic artery in four patients, and bilateral internal thoracic artery plus left radial artery in one patient, most frequently for right coronary artery revascularization. The patients underwent noninvasive diagnostic study during follow-up to evaluate their coronary status. The ten patients had no symptoms, and there was no mortality. Conclusions: Although survival was excellent after pediatric coronary bypass in our center, we need to continue the follow-up. Coronary revascularization by means of arterial grafting is a safe and reliable surgical modality for coronary disease in children.

Revascularization of the Right Coronary Artery in Bilateral Internal Thoracic Artery Grafting

2005 ◽  
Vol 79 (2) ◽  
pp. 564-569 ◽  
Author(s):  
Dmitry Pevni ◽  
Gideon Uretzky ◽  
Paz Yosef ◽  
Ben Gal Yanay ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Internal Thoracic Artery ◽  
Bilateral Internal Thoracic Artery ◽  
The Right

scholarly journals Bilateral internal thoracic artery grafting in children under 5 years of age with Kawasaki disease: a case series

2020 ◽  
Author(s):  
Yusuke Shimahara ◽  
Satsuki Fukushima ◽  
Naoki Tadokoro ◽  
Etsuko Tsuda ◽  
Takaya Hoashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Circulatory Collapse ◽  
Small Children ◽  
The Right ◽  
Children Under 5

Abstract Background Although persistent coronary artery aneurysm of Kawasaki disease (KD) is rare, some patients develop a life-threatening myocardial infarction. In paediatric coronary artery bypass surgery (PCABS), the internal thoracic artery (ITA) graft is a reliable graft with favourable coronary outcomes. However, few studies have reported the outcomes and technical considerations of PCABS using bilateral ITAs in small children who have multivessel disease. Case summary We present the cases of three children under 5 years of age who underwent PCABS utilizing bilateral ITAs. All three patients had known bilateral giant coronary aneurysms associated with KD. Paediatric coronary artery bypass surgery was indicated after confirming multiple coronary lesions with myocardial ischaemia. One child underwent emergency PCABS because of circulatory collapse. The arterial anastomoses were performed under cardioplegic arrest. The left ITA was anastomosed to the left anterior descending artery (LAD) or the circumflex artery. The right ITA was anastomosed to the right coronary artery or the LAD. Post-operative coronary angiography revealed patent bilateral ITA grafts with an excellent run-off in all patients, and none of them have suffered any subsequent coronary event. Discussion Bilateral ITA grafting is a feasible procedure with favourable coronary outcomes for treating small children with multivessel disease, even in the setting of circulatory collapse.

Abstract 16023: Network Meta-analysis of Randomized Controlled Trials for Graft Patency of a Second Conduit for Coronary Artery Bypass Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Coronary Artery ◽  
Graft Failure ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Graft Patency ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Right

Background: It has been well documented that the use of the left internal thoracic artery (LITA) to graft the left anterior descending (LAD) artery has a significant benefit in coronary artery bypass graft (CABG) surgery. However, what graft is the best as a second conduit to complement LITA-LAD anastomosis remains uncertain. We thus conducted a network meta-analysis of RCTs to compare graft patency of the radial artery (RA), the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), and saphenous vein (SVG) as a second conduit in CABG. Methods: MEDLINE and EMBASE were searched through February 8th, 2020 to identify randomized controlled trials (RCTs) that investigated graft patency of a second conduit in CABG. From each study, we extracted the incidence rate ratios (IRR) of the outcome. Results: A total of 11 RCTs were identified, including 3,434 patients and 2,171 angiographic results. There was no significant difference of IRR in graft failure among the 4 groups (vs. SVG: RA, IRR [95%CI] =0.66 [0.41-1.07]; RGEA, IRR [95% CI] =2.12 [0.54-8.38]; RITA, IRR [95% CI] =0.71 [0.32-1.60]). (Figure) Sensitivity analyses restricting trials with ≥3 years angiographic follow-up time or ≥5 years angiographic follow-up time showed no significant differences of IRR in graft failure among the four groups in both analyses. Conclusion: In a network meta-analysis of the updated outcomes from RCTs, no significant differences were observed in graft patency with the use of RA, RITA, RGEA or SVG as a second conduit in CABG.

scholarly journals Late results of coronary revascularization with saphenous vein and internal thoracic artery grafts

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 688
Author(s):  
Šarūnas Kinduris ◽  
Juozas Sakalauskas ◽  
Raimonda Verseckaitė ◽  
Gintarė Kaklauskaitė
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Saphenous Vein ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Late Results ◽  
Saphenous Veins ◽  
Obtuse Marginal ◽  
The Right

Objective. To evaluate the patency of saphenous vein and internal thoracic artery grafts by coronary system using angiographies performed in symptomatic patients after coronary artery bypass grafting. Material and methods. From 1999 to 2006, 685 patients (mean age, 59.1±11.8 years) had angiography of 538 internal thoracic and gastroepiploic artery and 1644 saphenous vein grafts. There were 580 (84.7%) males. The mean period from operation to the performance of reangiogram was 73.3±53.5 months. Graft failure was defined as >95% stenosis. The saphenous vein was grafted to the left anterior descending artery in 106 (6.4%), to the diagonal artery in 364 (22.1%), to the obtuse marginal artery in 629 (38.3%), and to the right coronary artery in 545 (33.1%) cases. Results. During the study, 1496 (68.97%) grafts were patent, and 686 (31.0%) had failed. Unadjusted 1-, 5-, 10-, and >10-year patency was 91.0%, 89.9%, 90.1%, and 75% for internal thoracic arteries and 79.9%, 68.6%, 57.4%, and 51.0% for saphenous veins, respectively. Conclusions. Internal thoracic arteries demonstrate better patency than saphenous veins except when grafting moderately stenosed coronary arteries. When bypassing coronary arteries with less than 70% stenosis, saphenous veins may be a better choice.

A Giant Right Coronary Artery of Diffuse Ectasia Induced by a Right Ventricular Fistula

2015 ◽  
Vol 18 (6) ◽  
pp. 253
Author(s):  
Renyuan Li ◽  
Yiming Ni ◽  
Peng Teng ◽  
Weidong Li
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Fistula ◽  
Rare Entity ◽  
Fistula Closure ◽  
Unique Case ◽  
Coronary Ectasia ◽  
The Right ◽  
Giant Size

<p>Coronary artery fistula (CAF) is a rare entity. Sometimes it may associate with mild diffuse or segmental coronary ectasia. CAF with giant coronary artery is exceptionally rare. We present a unique case of a 49-year-old female patient with a giant right coronary artery of diffuse ectasia coexisting with a fistula draining into the right ventricle. To our best knowledge, CAF with diffuse coronary ectasia of such giant size has never been reported. The patient was treated successfully by resection of the dilated right coronary artery, fistula closure, and coronary artery bypass grafting.</p>

Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

2016 ◽  
Vol 65 (04) ◽  
pp. 265-271
Author(s):  
Andrea Perrotti ◽  
Enrica Dorigo ◽  
Camille Durst ◽  
Djamel Kaili ◽  
Sidney Chocron ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
Bypass Graft ◽  
Myocardial Revascularization ◽  
Wound Complication ◽  
Safe Procedure ◽  
Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

scholarly journals Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Albuquerque ◽  
Pedro de Araújo Gonçalves ◽  
Hugo Marques ◽  
António Ferreira ◽  
Pedro Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Cardiac Death ◽  
Anomalous Origin ◽  
Cardiac Symptoms ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes

2021 ◽  
Vol 12 (6) ◽  
pp. 693-699
Author(s):  
Daouda Amadou ◽  
Julia Mitchell ◽  
Christian Bulescu ◽  
Olivier Metton ◽  
Roland Henaine ◽  
...  
Keyword(s):  
Physical Activity ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Early Death ◽  
Time Lapse ◽  
Single Center ◽  
Complete Restoration ◽  
Single Center Study ◽  
The Right

Background: Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. Methods: This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). Results: Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. Conclusions: Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.

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