scholarly journals Short-term results of bilateral internal mammary arterial grafting for patients aged 60–75 years – a retrospective study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yilong Guo ◽  
Xiaoqi Wang ◽  
Shuwu He ◽  
Yue Shu ◽  
Tianguang Wang ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulsatility Index ◽  
Graft Function ◽  
Operation Time ◽  
Left Ventricular ◽  
Short Term ◽  
Artery Graft ◽  
Significant Difference ◽  
Internal Mammary

Abstract Background Bilateral internal mammary artery (BIMA) grafting has a good long-term survival rate and graft patency rate, but it is only recommended in young patients due to its high technical requirements and high incidence of sternal complications. Previous studies indicated that BIMA grafting has a significant benefit in patients aged 50–59 years, but this benefit does not extend to patients aged > 60 years. Thus, this study was designed to analyse the immediate artery graft function, short-term (3 months) results, and experience in preventing sternal complications for BIMA grafting in elderly patients (60–75 years old). Methods Clinical records and echocardiographic and coronary artery computed tomography angiography data of 155 patients who underwent BIMA grafting for coronary artery disease between 2015 and 2017 in our hospital were analysed retrospectively to summarise the operative experience and short-term (3 months) results. Patients were divided into two groups: Group A (n = 95), aged < 60 years and Group B (n = 60), aged 60–75 years. The operation time, aortic clamp time, and cardiopulmonary bypass time of these two groups were compared to analyse the operation difficulty and the flow and pulsatility index were compared to analyse the immediate artery graft function. The left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) of these two groups were compared to analyse heart function. Results There were no significant differences in the operation time, aortic clamp time, and cardiopulmonary bypass time as well as the flow and pulsatility index between these two groups (P > 0.05). There was no significant difference in the incidence of sternal wound complications, graft occlusion, and other common complications 3 months post-BIMA grafting between these two groups (P > 0.05). Furthermore, there was no significant difference in LVEDD and LVEF between the groups 3 months post-operation (P > 0.05). Conclusions BIMA grafting was safe and effective for older patients (60–75 years). Similar to younger patients (< 60 years), BIMA grafting in elderly patients (60–75 years) can also achieve a satisfactory short-term (3 months) result. Thus, advanced age (60–75 years) should not be a contraindication for BIMA grafting.

scholarly journals Intelligent Algorithm-Based Magnetic Resonance Imaging in Radical Gastrectomy under Laparoscope

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wenkui Mo ◽  
Cansong Zhao
Keyword(s):  
Gastric Cancer ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Postoperative Hospital Stay ◽  
Intraoperative Blood Loss ◽  
Resonance Imaging ◽  
Intelligent Algorithm ◽  
Short Term ◽  
Laparoscopy Group ◽  
Significant Difference

The study focused on the influence of intelligent algorithm-based magnetic resonance imaging (MRI) on short-term curative effects of laparoscopic radical gastrectomy for gastric cancer. A convolutional neural network- (CNN-) based algorithm was used to segment MRI images of patients with gastric cancer, and 158 subjects admitted at hospital were selected as research subjects and randomly divided into the 3D laparoscopy group and 2D laparoscopy group, with 79 cases in each group. The two groups were compared for operation time, intraoperative blood loss, number of dissected lymph nodes, exhaust time, time to get out of bed, postoperative hospital stay, and postoperative complications. The results showed that the CNN-based algorithm had high accuracy with clear contours. The similarity coefficient (DSC) was 0.89, the sensitivity was 0.93, and the average time to process an image was 1.1 min. The 3D laparoscopic group had shorter operation time (86.3 ± 21.0 min vs. 98 ± 23.3 min) and less intraoperative blood loss (200 ± 27.6 mL vs. 209 ± 29.8 mL) than the 2D laparoscopic group, and the difference was statistically significant ( P < 0.05 ). The number of dissected lymph nodes was 38.4 ± 8.5 in the 3D group and 36.1 ± 6.0 in the 2D group, showing no statistically significant difference ( P > 0.05 ). At the same time, no statistically significant difference was noted in postoperative exhaust time, time to get out of bed, postoperative hospital stay, and the incidence of complications ( P > 0.05 ). It was concluded that the algorithm in this study can accurately segment the target area, providing a basis for the preoperative examination of gastric cancer, and that 3D laparoscopic surgery can shorten the operation time and reduce intraoperative bleeding, while achieving similar short-term curative effects to 2D laparoscopy.

scholarly journals On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Muhammad Sher-i-Murtaza ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Hemodynamic Instability ◽  
Bypass Grafting ◽  
Operative Strategy ◽  
Internal Mammary

Objective: To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery. Methods: The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19. Results: In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424. Conclusions: The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit. doi: https://doi.org/10.12669/pjms.35.3.988 How to cite this:Sher-i-Murtaza M, Baig MAR. On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study. Pak J Med Sci. 2019;35(3):---------.  doi: https://doi.org/10.12669/pjms.35.3.988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Development of Robotic Enhanced Endoscopic Surgery for the Treatment of Coronary Artery Disease

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Utz Kappert ◽  
Jens Schneider ◽  
Romuald Cichon ◽  
Vassilios Gulielmos ◽  
Sems-Malte Tugtekin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Surgical Tool ◽  
Internal Mammary ◽  
Artery Disease

Background The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team. Methods and Results Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64±10.5 years, left ventricular ejection fraction 68±12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (n=156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (n=37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (n=8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration. Conclusions The introduction of this new surgical tool enables the development of new endoscopic procedures. Our results gained during the development of robotic enhanced CABG motivate us to establish a set standard for the totally endoscopic treatment of patients with 1-vessel coronary artery disease.

scholarly journals Graft patency at 3 months after off- and on-pump coronary bypass surgery: a randomized trial

2019 ◽  
Vol 36 (2) ◽  
pp. 93-104 ◽  
Author(s):  
Lokeswara Rao Sajja ◽  
Kunal Sarkar ◽  
Gopichand Mannam ◽  
Venkata Krishna Kumar Kodali ◽  
Chandrasekar Padmanabhan ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Randomized Trial ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Conventional Coronary Angiography ◽  
Off Pump ◽  
Significant Difference ◽  
Pump Cabg

Abstract Purpose Coronary artery bypass grafting (CABG) is performed either with the aid of cardiopulmonary bypass (on-pump) or without cardiopulmonary bypass (off-pump). There is a scarcity of angiographic data to support the non-inferiority of off-pump technique to on-pump technique. The objective of this study is to ascertain the non-inferiority of off-pump CABG when compared to on-pump CABG in terms of angiographically assessed graft patency at 3 months. Methods A total of 320 patients with multivessel coronary artery disease were enrolled in a multicenter prospective randomized trial either to on-pump CABG (n = 162) or off-pump CABG (n = 158) between March 2016 through March 2017. Graft patency was evaluated by using either multidetector computerized tomographic angiography or conventional coronary angiography at 3 months. The major adverse cardiac and cardiovascular events (MACCE) were also analyzed at 3 months. Results The median number of grafts per patient in off-pump was 3.00 (Q1:3.00 and Q3:4.00) vs on-pump 4.00 (Q1:3.00 to Q3:4.00), and the mean number of grafts per patient was lower in the off-pump CABG at 3.45 ± 0.75 vs 3.64 ± 0.70 in the on-pump CABG (p = 0.01). There was no significant difference in mortality at 3 months between the off-pump (0.63%) and on-pump groups (1.85%) with p value of 0.62. The cumulative combined MACCE showed significant difference between off-pump group (0.63%) and on-pump group (5.55%), p = 0.01. Follow-up angiograms were done in 239 (75%) patients with 120 off-pump and 119 in the on-pump group. The analysis was also done regarding graft patency in a graded manner—when analysis of A (excellent) grafts vs B (stenosed) grafts and O (occluded) grafts were made, there was no statistically significant difference in overall graft patency at 3 months between on-pump [376 /429 grafts (87.6%)] and off-pump [366 /420 grafts (87.1%)] groups (p = 0.82). The patency rates were similar among bypass conduits (left internal thoracic artery (ITA) in off-pump (91.4%) vs on-pump (92.9%) p = 0.66, right ITA in off-pump (82.1%) vs on-pump (81.8%) p = 0.97, radial artery in off-pump (84.4%) vs on-pump (82.6%) p = 0.81; saphenous vein in off-pump (85.8%) vs on-pump (86.3%), p = 0.86 and among 3 coronary territories. Conclusions Off-pump CABG is non-inferior to on-pump CABG in terms of overall graft patency at 3 months and was associated with a fewer combined cumulative MACCE compared to on-pump CABG.

scholarly journals Percutaneous Transluminal Coronary Angioplasty (PTCA) and Stenting – Study of 100 Cases

1970 ◽  
Vol 26 (1) ◽  
pp. 26-31
Author(s):  
F Rahman ◽  
S Banerjee ◽  
CM Ahmed ◽  
MS Uddin ◽  
Khirul Anam ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angioplasty ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Clinical Results ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Short Term ◽  
Luminal Diameter ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

This prospective ongoing study conducted in University Cardiac Center, BSMMU, Dhaka from July 2004 to April 2006. 100 patients (mean age 52.4±6.2 years) underwent Percutaneous Transluminal Coronary angioplasty and stenting (PTCA & stenting) were evaluated. This study was designed to evaluate the short term angiographic and clinical results of stentangioplasty during hospital stay. The study group of 100 patients consisted of 88 (88%) men and 12 (12%) women. About risk factors 36 (36%) had hypertension, 30 (30%) were smoker, 20 (20%) suffered from diabetes mellitus, 14 (14%) had family history of ischaemic heart disease. Average Left ventricular ejection fraction was 54.2±7. Target vessel PTCA were done on 130 vessels, intracoronary stent implanted in 124 vessels, direct stenting was done in 80 cases, failed PTCA were in 4 (4%) cases, and three patients had dissection. The native vessels had a mean reference diameter of 2.89 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). Thombolysis in myocardial infarction (TIMI) flow analysis showed most of the patients had TIMI-1 flow (95,73%) before the procedure and maximum patients achieved TIMI-3 flow (91, 70%) after the procedure with significant clinical improvement. All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. So PTCA and Stenting is a safe and effective technique with high procedural success rate and good short-term (hospital) clinical results in the native coronary artery lesions. Key words: Coronary artery diseases; PTCA and stenting. DOI: 10.3329/jbcps.v26i1.4230 J Bangladesh Coll Phys Surg 2008; 26: 26-31

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