Reversal Flow in the Left Anterior Descending Artery After Internal Thoracic Artery Grafting

Abstract Background: The flow capacity of the in situ internal thoracic artery (ITA) is not necessarily sufficient and can be a cause of hypoperfusion syndrome. We present a catastrophic case of in situ ITA grafting for an isolated left main trunk obstruction 13 years after modified Bentall operation. Case presentation: A 33-year-old woman had previously undergone a modified Bentall operation. Coronary angiography showed a critical stenosis in the left coronary artery. The patient underwent emergent off-pump CABG with the left internal thoracic artery (ITA) to the left anterior descending artery (LAD). On the seventh day, the patient had severe dyspnoea and hypotension. Catheter angiography showed that the ITA was patent, but blood flow from the in situ ITA was delayed, and reversal flow from the apex to the proximal LAD was found. The patient underwent implantation of a left ventricular assist device. Conclusions: In conclusion, concomitant aortocoronary bypass to the circumflex branch will minimise the risk of hypoperfusion, especially for a young patient without atherosclerotic disease.

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Status of cardiovascular surgery in Japan between 2017 and 2018: A report based on the Japan cardiovascular surgery database 2. Isolated coronary artery bypass surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320981499 ◽

2021 ◽

pp. 021849232098149

Author(s):

Aya Saito ◽

Hiraku Kumamaru ◽

Noboru Motomura ◽

Hiroaki Miyata ◽

Shinichi Takamoto

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Internal Thoracic Artery ◽

Cardiovascular Surgery ◽

Artery Bypass ◽

Clinical Results ◽

Graft Material ◽

Off Pump ◽

Left Anterior Descending Artery ◽

Pump Coronary Artery Bypass

Background Clinical outcomes (as national clinical data) of isolated coronary artery bypass grafting have been successively reported, based on data registered in the Japan Cardiovascular Surgery Database, since 2013. In this study, we analysed the clinical results of isolated coronary artery bypass from 2017 to 2018 as a biannual report. Methods Data from the Japan Cardiovascular Surgery Database on isolated coronary artery bypass performed in 2017 and 2018 were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery. Results Isolated off-pump coronary artery bypass was performed in 54.6% ( n = 14,684) of all coronary artery bypass cases ( n = 26,913), and graft material for the left anterior descending artery was the left internal thoracic artery in 76.4% of cases and the right internal thoracic artery in 19.0% of cases. Operative mortality was 1.5% in elective cases (on-pump coronary artery bypass 1.9% and off-pump 1.2%, p < 0.001), 7.4% in emergency cases (on-pump 10.2% and off-pump 4.3%, p < 0.001), and 2.5% overall. Postoperative morbidity was generally lower in off-pump coronary artery bypass. The severity of surgery with expected mortality, evaluated using JapanSCORE II, is increasing every year. Conclusions Our findings suggest that short-term operative results for isolated coronary artery bypass are stable, and operative candidates are shifting to higher-risk patients.

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Outcomes of Off-Pump Coronary Bypass Grafting with the Bilateral Internal Thoracic Artery for Left Ventricular Dysfunction

Journal of Korean Medical Science ◽

10.3346/jkms.2014.29.1.69 ◽

2014 ◽

Vol 29 (1) ◽

pp. 69 ◽

Cited By ~ 4

Author(s):

Suryeun Chung ◽

Wook Sung Kim ◽

Dong Seop Jeong ◽

Jaejin Lee ◽

Young Tak Lee

Keyword(s):

Left Ventricular Dysfunction ◽

Internal Thoracic Artery ◽

Ventricular Dysfunction ◽

Coronary Bypass ◽

Left Ventricular ◽

Bypass Grafting ◽

Off Pump ◽

Coronary Bypass Grafting ◽

Bilateral Internal Thoracic Artery

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Numerical And Experimental Analysis Of Fracture Of Athrombogenic Coatings Deposited On Ventricular Assist Device In Micro-Shear Test

Archives of Metallurgy and Materials ◽

10.1515/amm-2015-0209 ◽

2015 ◽

Vol 60 (2) ◽

pp. 795-800 ◽

Cited By ~ 3

Author(s):

M. Kopernik ◽

A. Milenin ◽

S. Kąc

Keyword(s):

Residual Stress ◽

Ventricular Assist Device ◽

Shear Test ◽

Left Ventricular ◽

Scale Model ◽

Stress And Strain ◽

Assist Device ◽

Ventricular Assist ◽

Multilayer Wall

Abstract The Polish left ventricular assist device (LVAD – RELIGA_EXT) will be made of thermoplastic polycarbonate-urethane (Bionate II) with deposited athrombogenic nano-coatings: gold (Au) and titanium nitride (TiN). Referring to the physical model, the two-scale model of LVAD developed in the previous works in the authors’ finite element code is composed of a macro-model of blood chamber and a micro-model of wall: TiN, Au and Bionate II. The numerical analysis of stress and strain states confirmed the possibility of fracture based on localization of zones of the biggest values of triaxiality factor. The introduction of Au interlayer between TiN and polymer improved the toughness of the connection, and increased the compressive residual stress in the coating what resulted in reduction of stress and strain close to the boundary between substrate and coating. However, the proper design of multilayer wall of the medical device requires the introduction of the real stress and strain states in the deposited coatings. The characteristics of TiN nano-coating such as residual stress, material model and fracture model were determined in the previously completed studies such as experimental and numercial nanoindentation tests, profilometry studies and in situ SEM’s micro-tension tests. The experimental in situ SEM’s micro-shear test was performed in the present paper and the corresponding numerical model of the test was also developed, and then, interpreted. The critical strains taken from experiment and considered as the effective strains in the model of test are the values which are the function of triaxiality factors for the tested samples. The developed in the authors’ FE code model of multilayer wall of VAD enriched with critical strain determined in the present paper enables prediction of fracture.

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Life on the driveline: Molecular detection and fluorescence in situ hybridization-based visualization of microbial species in patients with left ventricular assist devices

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2017.09.023 ◽

2018 ◽

Vol 37 (1) ◽

pp. 163-166 ◽

Cited By ~ 3

Author(s):

Felix Schoenrath ◽

Judith Kikhney ◽

Laura Kursawe ◽

Katharina Schoenrath ◽

Maria M. Hajduczenia ◽

...

Keyword(s):

In Situ Hybridization ◽

Fluorescence In Situ Hybridization ◽

Molecular Detection ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Ventricular Assist ◽

Microbial Species ◽

Left Ventricular Assist

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Unplanned left ventricular assist device insertion after elective low-risk off-pump coronary artery revascularization

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/s1053-0770(03)00157-5 ◽

2003 ◽

Vol 17 (4) ◽

pp. 499-501

Author(s):

Sumeet Goswami ◽

Julian D Pamm ◽

Elliott Bennett-Guerrero

Keyword(s):

Coronary Artery ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Low Risk ◽

Assist Device ◽

Ventricular Assist ◽

Off Pump ◽

Coronary Artery Revascularization ◽

Left Ventricular Assist

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Bilateral internal thoracic artery grafting: propensity analysis of the left internal thoracic artery versus the right internal thoracic artery as a bypass graft to the left anterior descending artery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz290 ◽

2019 ◽

Author(s):

Shinji Ogawa ◽

Tomohiro Tsunekawa ◽

Soh Hosoba ◽

Yoshihiro Goto ◽

Takayoshi Kato ◽

...

Keyword(s):

Internal Thoracic Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Graft Patency ◽

Chronic Obstructive ◽

Left Internal Thoracic Artery ◽

Left Anterior Descending Artery ◽

Statistical Adjustment ◽

Right Internal Thoracic Artery

Abstract OBJECTIVES To compare different configurations of the bilateral internal thoracic arteries for the left coronary system and examine early and late outcomes, including mid-term graft patency. METHODS We reviewed 877 patients who underwent primary isolated coronary artery bypass grafting using in situ bilateral internal thoracic arteries [in situ right internal thoracic artery (RITA)-to-left anterior descending artery (LAD) grafting, n = 683; in situ left internal thoracic artery (LITA)-to-LAD grafting, n = 194]. We compared mid-term patency between the grafts. Propensity score matching was performed to investigate early and long-term outcomes. RESULTS The 2-year patency rate for RITA-to-LAD and LITA-to-LAD grafts were similar. Multivariate analysis revealed that RITA-to-non-LAD anastomosis (P = 0.029), postoperative length of stay (P = 0.003) and chronic obstructive pulmonary disease (P = 0.005) were associated with graft failure. After statistical adjustment, 176 propensity-matched pairs were available for comparison. RITA-to-LAD grafting enabled a more distal anastomosis. Kaplan–Meier analysis revealed that the incidences of death, repeat revascularization and myocardial infarction were significantly higher in the LITA-to-LAD group among both the unmatched and matched samples (P = 0.045 and 0.029, respectively). CONCLUSIONS The mid-term patency and outcomes of RITA-to-LAD grafting are good and reduces future cardiac event, in contrast to LITA-to-LAD grafting.

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