Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

Abstract Background: A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA.Methods:There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared.Results: There was no difference in the early postoperative death and major complications between group I and Group II(P＞0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7±6.2 vs 73.1±6.8, P=0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7±34.4ml/min vs 31.4±21.4ml/min, P=0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P＞0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value(71.4±7.8 vs 61.8±18.1 ,P=0.025).The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup(3.0±1.6 vs 2.1±1.0,P=0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent.ConclusionsThe use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Download Full-text

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

10.21203/rs.3.rs-70043/v1 ◽

2020 ◽

Author(s):

Zengqiang Han ◽

Guodong Zhang ◽

Shenglong Chen ◽

Gang Liu ◽

Yu Chen

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Internal Mammary Artery ◽

Bypass Graft ◽

Clinical Results ◽

Term Survival ◽

Group I ◽

Internal Mammary ◽

Group Ii

Abstract Background: A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA. Methods: There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared. Results: There was no difference in the early postoperative death and major complications between group I and Group II(P༞0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P༞0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value(71.4 ± 7.8 vs 61.8 ± 18.1 ,P = 0.025).The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup(3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent. Conclusions The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Download Full-text

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01380-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zengqiang Han ◽

Guodong Zhang ◽

Shenglong Chen ◽

Gang Liu ◽

Yu Chen

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Internal Mammary Artery ◽

Bypass Graft ◽

Clinical Results ◽

Term Survival ◽

Group I ◽

Internal Mammary ◽

Group Ii

Abstract Background A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA. Methods There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared. Results There was no difference in the early postoperative death and major complications between group I and Group II(P>0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1,P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent. Conclusions The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Download Full-text

The effect of nebivolol on internal mammary artery blood flow during coronary artery bypass graft surgery

Perfusion ◽

10.1177/0267659113517921 ◽

2013 ◽

Vol 29 (4) ◽

pp. 315-320 ◽

Cited By ~ 2

Author(s):

S Sarikaya ◽

A Onk ◽

B Boztosun ◽

G Kocabay ◽

M Sahin ◽

...

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Blood Flow ◽

Artery Bypass Graft ◽

Internal Mammary

Download Full-text

Topical Vasodilator Response is Significantly Higher in Skeletonized Internal Mammary Artery

Global Journal of Health Science ◽

10.5539/gjhs.v9n4p279 ◽

2016 ◽

Vol 9 (4) ◽

pp. 279

Author(s):

Nida Butt ◽

Sarah Hamid ◽

Mujtaba Hussain ◽

Ali Alam ◽

Hala Soomro ◽

...

Keyword(s):

Blood Flow ◽

Coronary Artery ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Internal Mammary ◽

The Difference

AIM OF THE STUDY: Coronary artery bypass graft surgery is the gold standard for the treatment of multi-vessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after application of topical vasodilator in skeletonized and pedicled IMA.METHODS: In this study, each patient underwent either skeletonized (n=25) or pedicled IMA harvesting (n=25). The type of graft on each individual patient was decided randomly. Intra-operative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in-vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions; before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study.RESULTS: The blood flow before application of topical vasodilator was similar in both the groups (P=0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001).CONCLUSION: Our study signifies that skeletonization of IMA results in increased graft length and blood flow especially after the application of topical vasodilator. However, we recommend that long term clinical trials should be conducted to fully determine long term patency rates of skeletonized IMA.

Download Full-text

Incidence and Risk Factors for Surgical Site Infection Following Coronary Artery Bypass Graft Procedures

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.152 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s77-s78

Author(s):

Polly van den Berg ◽

Sharon Wright ◽

Baevin Feeser

Keyword(s):

Risk Factors ◽

Blood Flow ◽

Coronary Artery ◽

Potential Risk ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Internal Mammary ◽

Potential Risk Factors

Background: Deep and organ-space surgical site infections (SSIs) are serious complications of coronary artery bypass graft (CABG) procedures. It is unclear whether the use of bilateral versus single internal mammary artery (BIMA vs SIMA) and surgical approach to internal mammary artery (IMA) harvest (pedicled vs skeletonized) are independent risk factors for SSI. The use of BIMA grafting redirects blood flow away from the sternum to the heart and may increase SSI risk due to lower tissue perfusion. A skeletonized approach to graft harvest, wherein the IMA is dissected free of surrounding tissue to preserve collateral sternal blood flow, may decrease SSI risk as compared to a pedicled approach in which the IMA is mobilized within a tissue pedicle. We describe the incidence and potential risk factors for post-CABG SSI in an academic tertiary-care center performing ~500 IMA procedures annually. Methods: Data were abstracted on adult patients who underwent a CABG procedure using at least 1 IMA graft between July 2017 and June 2020. Additional data on potential risk factors for SSI were obtained electronically from hospital data marts and the Division of Cardiac Surgery database, including demographics, comorbidities, number of arterial grafts, surgical approach, surgeon, and discharge location. Using standard NHSN definitions, infection control practitioners identified post-CABG deep and organ-space SSIs. Patient and procedure characteristics were evaluated as potential risk factors for deep and organ-space SSI using the Fisher exact test. Results: Of 1,591 CABG procedures performed during the study period, 1,244 (78.2%) were performed using a SIMA technique and 347 (21.8%) were performed using a BIMA technique. The overall post-CABG SSI incidence was 1.2 per 100 procedures, with 1.0 SSIs per 100 SIMA procedures and 1.7 SSIs per 100 BIMA procedures. Table 1 demonstrates an increase over time in proportion of CABG procedures performed using SIMA and skeletonized IMA grafts. We also observed a decrease in overall SSI incidence over this period. See Table 2 for univariate predictors of post-CABG SSI. Conclusions: Female sex, BMI ≥40, age ≥75 years, diabetes, and discharge to a rehabilitation setting were associated with development of post-CABG SSI. Although the overall incidence of deep and organ-space SSI in our cohort was very low, making it difficult to draw conclusions about potentially modifiable risk factors, an increase in the use of SIMA and skeletonized grafts appears to be accompanied by a decrease in SSI incidence. More data from our institution and others are needed to determine the significance of this trend.Funding: NoDisclosures: None

Download Full-text