scholarly journals Hospital Volume and Outcome after Bilateral Internal Mammary Artery Grafting

2020 ◽  
Vol 23 (4) ◽  
pp. E475-E481
Author(s):  
Andrea Perrotti ◽  
Daniel Reichart ◽  
Giuseppe Gatti ◽  
Giuseppe Faggian ◽  
Francesco Onorati ◽  
...  
Keyword(s):  
Hospital Volume ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
High Volume ◽  
Mixed Effects ◽  
Hospital Death ◽  
Deep Sternal Wound Infection ◽  
Internal Mammary ◽  
The Mean ◽  
Low Volume

Background: Bilateral internal mammary artery (BIMA) grafting largely is underutilized in patients undergoing coronary artery bypass grafting (CABG), partly because of the perceived increased complexity of the procedure. Aims: In this study, we evaluated whether BIMA grafting can safely be performed also in centers, where this revascularization strategy infrequently is adopted. Methods: Out of 6,783 patients from the prospective multicenter E-CABG study, who underwent isolated non-emergent CABG from January 2015 to December 2016, 2,457 underwent BIMA grafting and their outcome was evaluated in this analysis. Results: The mean number of BIMA grafting per center was 82 cases/year and hospitals were defined as high or low volume, according to this cutoff value. Six hospitals were considered as centers with a high volume of BIMA grafting (no. of procedures ranging from 120 to 267/year; overall: 2,156; prevalence: 62.2%) and nine hospitals as centers with a low volume of BIMA grafting (no. of procedures ranging from 2 to 39/year; overall: 301; prevalence: 9.1%). Multilevel mixed-effects regression analysis showed that the low- and high-volume cohorts had similar outcomes. Propensity score one-to-one matching analysis of 292 pairs showed that the low-volume cohort had a significantly shorter intensive care unit stay (2.2 ± 2.3 versus 2.9 ± 4.8 days, P = .020). The rates of in-hospital death (1.0% versus 0.3%, P = .625), deep sternal wound infection/mediastinitis (3.8% versus 3.1%, P = .824), and 1-year survival (98.1% versus 99.7%, P = .180) as well as other outcomes were similar between the high- and low-volume cohorts. Conclusions: BIMA grafting can be safely performed also in centers in which this revascularization strategy is infrequently performed.

Complete Coronary Revascularization via Left Anterior Thoracotomy

2019 ◽  
Vol 14 (4) ◽  
pp. 330-341 ◽  
Author(s):  
Oleksandr Babliak ◽  
Volodymyr Demianenko ◽  
Yevhenii Melnyk ◽  
Katerina Revenko ◽  
Liliya Pidgayna ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Internal Mammary ◽  
The Mean

Objective Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which is equally effective and safe compared with conventional coronary grafting technique, is reproducible, and can be applied in the vast majority of patients with isolated coronary artery disease. Methods From July 2017 to November 2018 a total of 170 nonselected consecutive patients underwent minimally invasive on-pump multivessel CABG through the left anterior minithoracotomy in the fourth intercostal space using a Chitwood clamp and blood cardioplegia. We named this technique total coronary revascularization via left anterior thoracotomy. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery in 4 (2.4%) patients, radial artery in 25 (14.7%) patients, and veins in 148 (87%) patients. Results We had no mortality, no postoperative myocardial infarcts, and no conversion to sternotomy. There were 2 postoperative strokes without residual neurological deficit and 2 revisions for postoperative bleeding. The total operation time was 258.8 ± 43.9 minutes, cardiopulmonary bypass time 135.8 ± 26.6 minutes, and aortic cross-clamp time 71.2 ± 19.4 minutes. The mean intensive care stay was 2.1 ± 0.56 days and mean total hospital stay 6.3 ± 1.3 days. Conclusions Complete coronary revascularization could be routinely performed using the above-mentioned technique. No patient selection, based on number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, or body mass index, is required.

scholarly journals Comparison of the Effect of Skeletonized and Pedicled Left Internal Thoracic Artery Harvesting Techniques in Coronary Artery Bypass Surgery

2020 ◽  
Vol 7 (48) ◽  
pp. 2841-2846
Author(s):  
Palanki Surya Satya Gopal ◽  
Sai Pavan Anne ◽  
Madhusudan Lal Kummari ◽  
Kaladhar Bomma ◽  
Amaresh Rao Malempati
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Severe Pain ◽  
Internal Mammary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Moderate Pain ◽  
Internal Mammary ◽  
Harvesting Techniques ◽  
The Mean

BACKGROUND We wanted to study the effect of 2 LIMA (Left Internal Mammary Artery) harvesting techniques (skeletonization and pedicled) on ITA’s (Internal Thoracic Arteries) flow, length, postoperative sternal wound infection and postoperative pain. METHODS This is a randomized controlled trial of the two different methods of internal mammary artery harvesting. The study was conducted in the Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences (NIMS) and included people undergoing coronary artery bypass grafting (CABG) over a period of 18 months from January 2016 to July 2017. RESULTS In study subjects, male participants were 28 (70 %). The mean flowrate of skeletonized group was 99.7 ± 5.03 and that of the pedicled group was 60.5 ± 3.97; the mean difference (39.2) between the two groups was statistically significant. The mean length of skeletonized group was 21.55 ± 2.26 and that of the pedicled group was 15.6 ± 2.39; the mean difference (5.95) between the two groups was statistically significant. In the skeletonized group, 1 (5 %) had no pain, 8 (40 %) had mild pain, 6 (30 %) had moderate pain, 4 (20 %) had severe pain, and 1 (5 %) had very severe pain. In the pedicled group, 6 (30 %) had mild pain, 6 (30 %) had moderate pain, 5 (25 %) had severe pain and 3 (15 %) had very severe pain. The difference in the proportion of postoperative sternal infections within the study group was statistically not significant. CONCLUSIONS Skeletonization technique has higher mean free flow (of the LIMA) and mean length (of the left internal thoracic artery graft) than that of pedicled technique. KEYWORDS Internal Thoracic Artery, Myocardial Revascularization, Skeletonization Technique

EP.FRI.496 Does hospital volume effect time to theatre in patients undergoing emergency laparotomy? A retrospective analysis of NELA data

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Stefan Tucker ◽  
Lachlan Dick ◽  
Fiona Bairstow ◽  
James Green ◽  
Jamie Young
Keyword(s):  
Hospital Volume ◽  
High Volume ◽  
Volume Effect ◽  
Emergency Laparotomy ◽  
Single Episode ◽  
Patient Pathways ◽  
The Mean ◽  
Low Volume ◽  
National Emergency ◽  
Effect Time

Abstract Aims Delays to theatre in patients undergoing emergency laparotomy are associated with poorer outcomes. It is unclear whether hospital volume impacts arrival to theatre within a time appropriate to urgency. We aimed to determine the association between hospital laparotomy volume and time to theatre for patients undergoing emergency laparotomy. Methods The National Emergency Laparotomy Audit aggregate hospital reports from years 1 – 6 were used to extract data relevant to the study aims. Hospitals were categorised into high, medium and low volume using inter-quartile ranges, with each year counting as a single episode. Statistical analysis was used to determine if there is a difference in arrival to theatre within a time appropriate to urgency. Results A total of 751 episodes were included, representing 193 high volume, 370 medium volume and 188 low volume hospitals. The mean proportion of patients arriving to theatre within a time appropriate to urgency were 81.5%, 83.5% and 85.3% respectively. There was no statistical difference between low to medium volume hospitals however, there was when comparing medium to high volume (p = <0.05) and low to high volume (p = <0.05) hospitals.  Conclusion Hospitals with low and medium emergency laparotomy volumes have fewer delays to theatre. Whilst it is likely to be multifactorial, it is important for hospitals to have efficient patient pathways in place to reduce delays. 

Mitral Valve Replacement via Anterolateral Right Thoracotomy without Cross-Clamping in a Patient with Fungal Infective Endocarditis and Functioning Internal Mammary Artery after Previous Coronary Artery Bypass Grafting and Mitral Valve Repair

2016 ◽  
Vol 19 (1) ◽  
pp. 033
Author(s):  
Takahiro Taguchi ◽  
Jeswant Dillon ◽  
Mohd Azhari Yakub
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Mitral Valve ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Valve Repair ◽  
Artery Bypass Grafting ◽  
Internal Mammary

A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.

High-Volume Hospitals with High-Volume and Low-Volume Surgeons: Is There a “Field Effect” for Pancreaticoduodenectomy?

2016 ◽  
Vol 82 (5) ◽  
pp. 407-411 ◽  
Author(s):  
Thomas W. Wood ◽  
Sharona B. Ross ◽  
Ty A. Bowman ◽  
Amanda Smart ◽  
Carrie E. Ryan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Field Effect ◽  
Hospital Volume ◽  
Patient Discharge ◽  
High Volume ◽  
Surgeon Volume ◽  
Hospital Charges ◽  
Leapfrog Group ◽  
Discharge Status ◽  
Low Volume

Since the Leapfrog Group established hospital volume criteria for pancreaticoduodenectomy (PD), the importance of surgeon volume versus hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine whether low-volume surgeons attain the same outcomes after PD as high-volume surgeons at high-volume hospitals. PDs undertaken from 2010 to 2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified. Surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges were examined relative to surgeon volume. Six high-volume hospitals were identified. Each hospital had at least one surgeon undertaking ≥ 12 PDs per year and at least one surgeon undertaking < 12 PDs per year. Within these six hospitals, there were 10 “high-volume” surgeons undertaking 714 PDs over the three-year period (average of 24 PDs per surgeon per year), and 33 “low-volume” surgeons undertaking 225 PDs over the three-year period (average of two PDs per surgeon per year). For all surgeons, the frequency with which surgeons undertook PD did not predict LOS, in-hospital mortality, discharge status, or hospital charges. At the six high-volume hospitals examined from 2010 to 2012, low-volume surgeons undertaking PD did not have different patient outcomes from their high-volume counterparts with respect to patient LOS, in-hospital mortality, patient discharge status, or hospital charges. Although the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there seems to be a hospital “field effect.”

Internal Mammary Artery Bypass Grafting in Left Main Stenosis

Cardiology ◽  
1993 ◽  
Vol 82 (5) ◽  
pp. 343-346
Author(s):  
Reinhard H&ouml;ltgen ◽  
Ruud Krijne ◽  
Karl-Wilhelm Heinrich ◽  
Hermann Sons ◽  
Arno Krian
Keyword(s):  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Left Main ◽  
Artery Bypass Grafting ◽  
Left Main Stenosis ◽  
Internal Mammary

Survival benefit from a second arterial conduit to the circumflex circulation persists in elderly after coronary artery bypass surgery

2021 ◽  
pp. 021849232199707
Author(s):  
Suvitesh Luthra ◽  
Miguel M Leiva-Juárez ◽  
Pietro G Malvindi ◽  
John S Billing ◽  
Sunil K Ohri
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Survival Benefit ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Arterial Graft ◽  
Arterial Conduit ◽  
Internal Mammary

Background This retrospective propensity matched study investigated the impact of age on the survival benefit from a second arterial conduit to the left-sided circulation. Methods Data for isolated coronary artery bypass surgery were collected from October 2004 to March 2014. All patients with an internal mammary artery graft to left anterior descending artery and additional arterial or venous graft to the circumflex circulation were included. Propensity matching was used to balance co-variates and generate odds of death for each observation. Odds ratios (venous vs. arterial) were charted against age. Results The in-hospital mortality rate was 1.12% (arterial) vs. 1.24% (venous) (p = 0.77). The overall 10-year survival was 74.6% (venous) vs. 82.6% (arterial) (p = 0.001). A total of 1226 patients were successfully matched to the venous or arterial (second conduit to circumflex territory after left internal mammary artery to left anterior descending artery) cohorts. Odds ratio for death (venous to arterial) showed a linear decremental overall survival benefit for the second arterial graft to circumflex circulation with increasing age. Conclusions The survival benefit of a second arterial graft persists through all age groups with a gradual decline with increasing age over the decades. Elderly patients should not be denied a second arterial graft to the circumflex circulation based on age criterion alone.

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