scholarly journals All we need to know about internal thoracic artery harvesting and preparation for myocardial revascularization: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Matiullah Masroor ◽  
Kang Zhou ◽  
Chunyang Chen ◽  
Xianming Fu ◽  
Yuan Zhao
Keyword(s):  
Clinical Practice ◽  
Internal Thoracic Artery ◽  
Harmonic Scalpel ◽  
Coronary Revascularization ◽  
Median Sternotomy ◽  
Myocardial Revascularization ◽  
Anterolateral Thoracotomy ◽  
Multiple Challenges ◽  
Single Standard

AbstractInternal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.

Is the Future of Coronary Arterial Revascularization a Hybrid Approach?

2017 ◽  
Vol 12 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Vincenzo Giambruno ◽  
Ahmad Hafiz ◽  
Stephanie A. Fox ◽  
Hugues Jeanmart ◽  
Richard C. Cook ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Surgical Trauma ◽  
Stent Patency ◽  
Left Internal Thoracic Artery ◽  
The Mean ◽  
Hybrid Coronary Revascularization

Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up. Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months. Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization. Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.

Multimodality Targeted Approach in Redo Off-Pump Coronary Artery Bypass Surgery

2003 ◽  
Vol 11 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Yugal K Mishra ◽  
Harpreet Wasir ◽  
Surendra N Khanna ◽  
Sameer Shrivastava ◽  
Yatin Mehta ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Left Anterior Descending Artery ◽  
The Mean ◽  
Targeted Approach

Records of 86 patients who underwent off-pump redo coronary revascularization between December 1997 and December 2000, were analyzed. Approaches included median sternotomy (47), anterolateral thoracotomy for left anterior descending artery and diagonal targets (35), posterolateral thoracotomy for the obtuse marginal with proximal anastomosis on descending aorta (3), and a combined subxiphoid-anterior thoracotomy approach (1) for right gastroepiploic artery-to-left anterior descending artery anastomosis. The mean age was 61.82 years. There were 2 (2.3%) operative deaths. Complications included perioperative myocardial infarction in 4 patients and reexploration for bleeding in one. Blood transfusion was required in 12 patients. The mean length of hospital stay was 5 ± 2 days. A multimodality targeted approach for off-pump redo coronary artery bypass offers a less invasive but safer method of myocardial revascularization, with decreased complications, lower blood product requirement, and early hospital discharge.

14-Year Results of Bilateral versus Single Internal Thoracic Artery Grafts for Left-Sided Myocardial Revascularization in Young Diabetic Patients

2016 ◽  
Vol 65 (04) ◽  
pp. 272-277 ◽  
Author(s):  
Alem Delalic ◽  
Edgar Eszlari ◽  
Walter Eichinger ◽  
Brigitte Gansera
Keyword(s):  
Internal Thoracic Artery ◽  
Survival Rates ◽  
Myocardial Revascularization ◽  
Wound Complications ◽  
Diabetic Patients ◽  
Deep Sternal Wound Infection ◽  
Term Survival ◽  
Increased Risk

Objectives Despite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal wound complications. In the present study, early- and long-term outcomes of the use of left-sided BITA versus single internal thoracic artery (SITA) grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively. Methods A total of 250 propensity score pair-matched diabetic patients, operated on between February 2000 and December 2011, receiving either BITA (n = 125) or SITA (n = 125) grafting were analyzed retrospectively. In each group, 104 patients were males, and mean age was 60.1 ± 5.3 years. Follow-up was 2.1 to 14.8 years (mean, 9.3 ± 3.5 years) and complete for 100%. Results Incidence of deep sternal wound infection was 2.4 versus 3.2% (p = 0.722). Rethoracotomy due to bleeding occurred in 4.8 versus 3.2% (p = 0.608). The 5-, 10-, and 14-year estimates of survival were 93.4, 76.6, and 67.5% (BITA) versus 89.5, 81.5, and 32.8% (SITA); p = 0.288. Freedom from reangiography/intervention (60.5 vs. 63.9%) during follow-up was comparable (p = 0.507) as well as infarction rate (93.8 vs. 95.1%, p = 0.833) and redoes (p = 0.672, exclusively valve surgery) were comparable. Freedom from thromboembolic or cerebrovascular events did not show any significant differences (94.0 vs. 94.0%, p = 0.78). Multivariate analysis identified poor ejection fraction as predictor for decreased long-term survival. Neither age nor gender or urgency had an influence on long-term mortality. Conclusion Left-sided BITA grafting may be performed routinely even in diabetic patients without increased incidence of postoperative wound-healing complications. Survival rates after 5, 10, and 14 years were comparable for BITA and SITA grafting.

Surgical management for cardiovascular lesions in Kawasaki disease

1991 ◽  
Vol 1 (3) ◽  
pp. 240-253 ◽  
Author(s):  
Soichiro Kitamura
Keyword(s):  
Kawasaki Disease ◽  
Internal Thoracic Artery ◽  
Myocardial Revascularization ◽  
Therapeutic Modality ◽  
Bypass Grafting ◽  
Obstructive Disease ◽  
Results Of Surgery

SummarySummary Myocardial revascularization is now an accepted therapeutic modality for severe coronary arterial obstructive disease produced by Kawasaki disease which is amenable to usual medical treatment. The mortality rate of myocardial infarction is surprisingly high in this setting, and surgery may be able to prevent many of these deaths. This article focuses on current issues in surgical treatment of ischemic heart disease in children secondary to Kawasaki disease. Coronary arterial obstructive disease is, apparently, a leading problem followed by valvar and myocardial involvements. Introduction of bypass grafting using the internal thoracic artery in children was a major recent advance, because this graft has an excellent capability to adapt to the increments of increased flow and growth of the patient. The saphenous vein is less satisfactory when used as a graft in terms of its long-term patency, particularly in young children less than 8 years old. Although longer follow-up is certainly required, the current results of surgery have been excellent in improving myocardial perfusion, in ameliorating symptoms, and improving the quality of life.

scholarly journals Selection of the transplant for myocardial revascularization

2018 ◽  
Vol 177 (5) ◽  
pp. 96-99
Author(s):  
G. G. Khubulava ◽  
A. S. Nemkov ◽  
V. V. Komok ◽  
Yi. Chzan
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Clinical Practice ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Bypass Grafting ◽  
Selection Of

Surgical treatment of coronary heart disease was introduced into clinical practice more than 50 years ago. Only one intervention – the use of left internal thoracic artery for bypass grafting of the anterior interventricular artery – Kolovos’s operation– remains practically unchangeable version of execution as a standard for coronary artery bypass grafting. This review summarizes the half-century use of internal thoracic arteries, autoveins, radiate arteries as conduits for coronary arteries on the basis of the randomized studies and meta-analyzes published by 2018.

scholarly journals Robotic off-pump hybrid coronary revascularization - a niche area in need for objective data.

2022 ◽  
Author(s):  
Pradeep Narayan ◽  
Gianni Angelini
Keyword(s):  
Bypass Surgery ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Beating Heart ◽  
Objective Data ◽  
Off Pump ◽  
Niche Area ◽  
Hybrid Coronary Revascularization

Hybrid coronary revascularization (HCR) consists of left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery and transcatheter revascularization of the non-LAD stenosis in specific settings to achieve complete coronary revascularization. Technique to perform the LITA to LAD graft has ranged from median sternotomy with cardiopulmonary bypass to robotically assisted totally endoscopic coronary bypass surgery using beating heart revascularization.

Left anterior descending artery revascularization with the right internal thoracic artery T-graft: the ‘reverse composite’ configuration

2019 ◽  
Vol 29 (6) ◽  
pp. 830-835
Author(s):  
Yael Ag-Rejuan ◽  
Dmitry Pevni ◽  
Nachum Nesher ◽  
Amir Kramer ◽  
Yosef Paz ◽  
...  
Keyword(s):  
Internal Thoracic Artery ◽  
Myocardial Revascularization ◽  
Circumflex Artery ◽  
Term Survival ◽  
Long Term Survival ◽  
Left Circumflex Artery ◽  
Left Anterior Descending Artery ◽  
Composite Grafts ◽  
The Right

Abstract OBJECTIVES The use of bilateral internal thoracic artery graft for myocardial revascularization has improved the long-term survival and decreased the rate of repeat interventions in patients. A key technical factor for complete arterial revascularization is sufficient length of the internal thoracic artery (ITA) graft. The purpose of this study was to compare early and long-term outcomes of ‘standard composite’ grafting and ‘reverse composite’ grafting. In the former, the left ITA (LITA) is connected to the left anterior descending artery, and the right ITA is connected end-to-side to the LITA for revascularization of the left circumflex artery. In ‘reverse composite’ grafting, the LITA is connected to the left circumflex artery, and the right ITA is connected end-to-side to the LITA, for revascularization of the left anterior descending artery. METHODS We compared the outcomes of 1365 patients who underwent coronary artery bypass grafting in Tel-Aviv Sourasky Medical Centre, using bilateral ITA as standard composite versus ‘reverse composite’ grafts, between January 1996 and December 2011. A propensity score matching analysis compared 132 pairs of patients who underwent bilateral ITA by the 2 modes. RESULTS Twelve hundred and thirty patients underwent standard ‘composite’ grafts and 135 underwent ‘reverse composite’ grafts. Early mortality and early adverse effects did not differ significantly between the groups. After matching, the difference in late mortality between the groups was not statistically significant. CONCLUSIONS This study suggests that revascularization of the left anterior descending with the right ITA, arising from an in situ LITA, is safe and provides early outcomes and long-term survival that are not significantly different from those of the standard composite grafting technique. However, there was evidence of better survival in the standard composite group.

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