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bilateral mammary cabg

Kamales Kumar Saha, Saurab Goel, Ajay Kumar, Kakalee K Saha
A 64 years old male diabetic patient with ejection fraction of 16% and renal dysfunction underwent off-pump CABG using both in situ internal mammary artery grafts. Left internal mammary artery was used to bypass left anterior descending artery and right internal mammary artery was used as composite graft. Patient had uneventful recovery and left ventricular ejection fraction improved to 34% within 8 months after surgery. In presence of left ventricular dysfunction, both internal thoracic artery grafting should be preferred for better patency rate and flow reserve...
September 2016: Indian Heart Journal
Kristina Lenz, Michael Brandt, Sandra Fraund-Cremer, Jochen Cremer
The incidence of sternal wound infections (SWI) after coronary artery bypass surgery (CABG) as reported worldwide is low. However, it is associated with significant increase of postoperative mortality and treatment costs. The major risk factors discussed are diabetes mellitus and bilateral IMA harvesting of the internal mammary artery. This study analyses data of 590 patients receiving CABG concerning the risk factors for SWI. Sternal wound infections occur significantly more often in diabetic patients, one crucial and significant additional risk factor is obesity...
2016: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
Ahmed Abdulaziz Abuzaid, Mahmood Zaki, Habib Al Tarief
OBJECTIVE: The purposes of this study were to determine the incidence of surgical site infections (SSI) and associated risk factors in patients undergoing isolated coronary artery bypass grafting (CABG) in our cardiac center during a 2-year period. MATERIALS AND METHODS: Retrospective case-control analysis for 80 patients who underwent isolated cardiac surgery CABG. These patients were divided into the SSI study group (n = 40) and the noninfected control group (n = 40)...
July 2015: Heart Views: the Official Journal of the Gulf Heart Association
Emmeline Ruka, François Dagenais, Siamak Mohammadi, Vincent Chauvette, Paul Poirier, Pierre Voisine
OBJECTIVES: The prevalence of obesity has risen in the last decade, increasing the percentage of obese patients who undergo cardiac surgery. Deep sternal wound infection (DSWI) is a rare but devastating postoperative complication, more often encountered in the obese population. DSWI is also associated with the use of bilateral internal mammary artery (BIMA), particularly in this high-risk population. The aim of this study is to determine the short-term and long-term outcomes following BIMA revascularization in obese patients...
May 26, 2016: European Journal of Cardio-thoracic Surgery
David Glineur, Spiridon Papadatos, Juan B Grau, Richard E Shaw, Cyrus E Kuschner, Gaby Aphram, Yves Mairy, Christophe Vanbelighen, Pierre Yves Etienne
OBJECTIVES: Bilateral internal thoracic artery (BITA) bypass provides long-term survival benefits over strategies that use single internal mammary arteries during coronary artery bypass grafting (CABG). However, the rate of adoption of this strategy remains very low. Moreover, optimal BITA configuration and the use of cardiopulmonary bypass still remain a matter of debate. We investigated the long-term results of a coronary revascularization strategy, utilising exclusively BITA-Y composite grafts using off-pump platform and sequential anastomoses...
April 15, 2016: European Journal of Cardio-thoracic Surgery
Teresa M Kieser, M Sarah Rose, Stuart J Head
OBJECTIVES: The purpose of this study was to compare effectiveness of the 1999 logistic EuroSCORE (LES) and of the 2012 EuroSCORE II (ESII) in a real-world patient population of 1125 patients undergoing total arterial grafting (TAG) coronary artery bypass graft (CABG) surgery. METHODS: The performance of the two risk scores was compared using (i) discrimination (accuracy of discriminating non-survivors from survivors), (ii) calibration (assessment of agreement between the predicted/observed outcomes) and (iii) agreement between the two scores...
September 2016: European Journal of Cardio-thoracic Surgery
Joshua M Rosenblum, Ralf E Harskamp, Niels Hoedemaker, Patrick Walker, Henry A Liberman, Robert J de Winter, Thomas A Vassiliades, John D Puskas, Michael E Halkos
OBJECTIVE: Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery (LIMA)-left anterior descending artery (LAD) bypass with percutaneous intervention of non-LAD vessels. The purpose of this study was to compare outcomes of HCR to conventional coronary artery bypass graft (CABG) surgery with single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting. METHODS: Between October 2003 and September 2013, 306 consecutive patients who underwent HCR were compared with 8254 patients who underwent CABG with SIMA (7381; 89...
April 2016: Journal of Thoracic and Cardiovascular Surgery
Siamak Mohammadi, François Dagenais, Pierre Voisine, Eric Dumont, Eric Charbonneau, Mohamed Marzouk, Andreas Paramythiotis, Dimitri Kalavrouziotis
BACKGROUND: Bilateral internal mammary artery (BIMA) grafting has been associated with improved long-term outcomes after CABG. We sought to evaluate the early results and long-term survival among coronary artery bypass graft patients who underwent in-situ BIMA grafting with the radial artery (RA) as an additional arterial conduit compared with those who underwent BIMA with additional saphenous vein graft (SVG). METHODS: Between 1991 and 2013, 1,750 consecutive patients with triple-vessel disease or left main plus right coronary system disease underwent primary isolated in-situ BIMA grafting with at least one internal mammary artery to the left anterior descending artery...
March 2016: Annals of Thoracic Surgery
Benjamin M Robinson, Hugh S Paterson, Rishendran Naidoo, Vikrant Dhurandhar, A Robert Denniss
BACKGROUND: The use of bilateral internal thoracic arteries (BITA) in coronary artery bypass graft surgery improves patient survival. The optimum BITA graft configuration is unknown. This study evaluates outcomes after the use of bilateral internal mammary Y grafting as the primary grafting strategy. METHODS: Patients who underwent BITA composite Y grafting (n = 1,011) between October 1994 and March 2009 were identified from a cardiac surgical database. Follow-up (mean 12 years) was obtained by cross-reference with the state death registry and local cardiology databases...
March 2016: Annals of Thoracic Surgery
Keita Kikuchi, Dai Une, Yoshiki Endo, Takayoshi Matsuyama, Yasuhisa Fukada, Atsushi Kurata
When performing minimally invasive coronary artery bypass grafting (MICS CABG), it is difficult to access the right internal thoracic artery (ITA) under direct vision. We successfully performed off-pump MICS CABG using the bilateral in situ ITAs through a 8-cm left thoracotomy under direct vision for a 76-year-old man. His postoperative course was uneventful and all the grafts were patent. This novel, minimally invasive approach safely preserves the sternum and delivers the benefits of bilateral in situ ITA grafting, providing an alternative to conventional CABG and off-pump CABG...
September 2015: Annals of Thoracic Surgery
George Jose Valooran, Shiv Kumar Nair, Krishnan Chandrasekharan
BACKGROUND: The advent of percutaneous intervention has made surgical treatment of coronary artery disease less favored by patients though the evidence that supports CABG in certain patient subsets is strong. METHODS: Literature review was done using Pubmed, Scopus, Google and Google Scholar with MeSH terms-coronary artery bypass grafting, internal mammary artery, drug eluting stent, stroke, myocardial revascularization. RESULTS: The adoption of evolving techniques like anaortic off pump grafting, bilateral internal mammary artery use, hybrid and minimally invasive coronary revascularization techniques, intra-operative graft assessment, and heart team approach can lead to better outcomes following surgery as is evidenced by recent literature...
July 2015: Indian Heart Journal
J Trent Magruder, Joshua C Grimm, Samuel P Dungan, Ashish S Shah, Jessica R Crow, Bethany R Shoulders, Laeben Lester, Viachaslau Barodka
OBJECTIVES: The authors sought to determine whether an institutional transition from intermittent to continuous dosing of intraoperative antibiotics in cardiac surgery affected surgical site infection (SSI) outcomes. DESIGN: A retrospective chart review utilizing propensity matching. SETTING: A single academic, tertiary care hospital. PARTICIPANTS: One thousand one hundred seventy-nine patients undergoing coronary artery bypass grafting (CABG) and/or cardiac valvular surgery between April 2013 and November 2014 who received perioperative cefazolin...
December 2015: Journal of Cardiothoracic and Vascular Anesthesia
Ming Yang, Yang Wu, Gang Wang, Cangsong Xiao, Huajun Zhang, Changqing Gao
BACKGROUND: Coronary artery bypass grafting (CABG) is the gold-standard treatment for coronary artery disease, but the long-term benefits of robotic CABG remain unclear. METHODS: Between January 2007 and November 2014, 240 consecutive patients (187 male and 53 female, average age 59 years) underwent robotic off-pump CABG with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) in our center. Totally endoscopic coronary artery bypass (TECAB) (n = 100) or mini-thoracotomy coronary artery bypass (MINICAB) (n = 140) grafting was performed with skeletonized internal mammary arteries (IMA)...
October 2015: Annals of Thoracic Surgery
Juan B Grau, Cyrus E Kuschner, Christopher K Johnson, Giovanni Ferrari, Alex Zapolanski, Mariano E Brizzio, Richard E Shaw
OBJECTIVES: Recent studies have demonstrated the superiority of bilateral internal mammary arteries (BIMAs) as conduit material for coronary artery bypass grafting (CABG) surgery. However, there is limited research on the effects of other graft conduits used in patients who require additional bypasses. The goal of this study was to evaluate the impact of the radial artery (RA) when used in conjunction with the BIMAs. METHODS: From the beginning of 2000 to the end of 2013, 4370 patients underwent CABG for three or more vessels at our institution...
January 2016: European Journal of Cardio-thoracic Surgery
Damien J LaPar, Ivan K Crosby, Jeffrey B Rich, Mohammed A Quader, Alan M Speir, John A Kern, Curt Tribble, Irving L Kron, Gorav Ailawadi
BACKGROUND: Bilateral internal mammary arterial (BIMA) grafts have repeatedly demonstrated superior outcomes compared with single IMA (SIMA) after coronary artery bypass grafting (CABG). Despite known survival benefits with BIMA use, perceived perioperative challenges often preclude BIMA use. We hypothesized that the use of BIMA remains underutilized, even in low-risk patients. METHODS: A total of 43,823 primary, isolated CABG patients in a regional Society of Thoracic Surgeons Database were evaluated...
July 2015: Annals of Thoracic Surgery
Shinji Ogawa, Yasuhide Okawa, Koshi Sawada, Yoshihiro Goto, Masanori Yamamoto, Yutaka Koyama, Hiroshi Baba, Takahiko Suzuki
OBJECTIVES: Deep sternal wound infection (DSWI), especially in patients with diabetes mellitus (DM), is a major concern after coronary artery bypass grafting (CABG) with bilateral internal mammary artery (BIMA) grafts. We evaluated the risk of DSWI and other clinical outcomes between continuous insulin infusion therapy (CIT) and insulin sliding scale therapy (IST) in a cohort of DM patients who underwent CABG with BIMA. METHODS: The clinical records of DM patients who underwent isolated CABG with BIMA were retrospectively reviewed...
February 2016: European Journal of Cardio-thoracic Surgery
Juan B Grau, Christopher K Johnson, Cyrus E Kuschner, Giovanni Ferrari, Richard E Shaw, Mariano E Brizzio, Alex Zapolanski
OBJECTIVE: Previous studies have demonstrated that bilateral internal mammary artery (BIMA) grafts lead to superior outcomes compared with single internal mammary artery grafts. This study examines whether cardiopulmonary bypass affects conduit-dependent outcomes of coronary artery bypass grafting (CABG) surgery. METHODS: From 1994 to 2013, a total of 6666 patients underwent isolated CABG surgery at our institution. Of these procedures, 3548 (53.2%) were performed off pump...
April 2015: Journal of Thoracic and Cardiovascular Surgery
Jeremiah Umakanthan, Panch Jeyakumar, Branavan Umakanthan, Nikeshan Jeyakumar, Nadarajah Senthilkumar, Mathioli R Saraswathy, Padminidevi Umakanthan, Janani Umakanthan, Tamoor Sial, Sofia Abrina, Frances M Buendia, Irene Pan, Ramadas K Kamath, Canagaratnam Pathmarajah, Kanagaratnam Sivalingam, Shan A Nathan, Shun K Sunder, Tom Mahendra, Ramanan Umakanthan
The left internal mammary artery (LIMA) graft is considered the "gold standard" of coronary artery bypass grafting (CABG). This conduit provides increased survival, symptomatic relief, increased freedom from myocardial infarction, and increased freedom from re-intervention when compared to saphenous venous grafting. It has a remarkable long term patency rate with clinical and angiographic outcomes that are unmatched by other conduits. Given the fact that patients often require more than one graft during a coronary revascularization procedure, the prospect of bilateral internal mammary artery (BIMA) grafting has been very appealing to some surgeons...
April 2015: International Journal of Surgery
Kan Kajimoto, Taira Yamamoto, Atsushi Amano
This study examined the effect of coronary artery bypass graft surgery with bilateral internal thoracic artery grafting in diabetic patients. Coronary artery bypass graft surgery using skeletonized bilateral internal thoracic artery grafts was not associated with an increased risk of deep sternal wound infection or early death. Moreover, patients who underwent coronary artery bypass graft surgery using bilateral internal thoracic artery grafting had lower remote mortality and cardiac mortality. We conclude that coronary artery bypass surgery using bilateral internal thoracic artery grafts is an excellent strategy, even for diabetic patients...
March 2015: Annals of Thoracic Surgery
Piroze M Davierwala, Friedrich W Mohr
Coronary artery bypass graft (CABG) surgery remains the preferred mode of revascularization in patients with complex multi-vessel coronary artery disease. The left internal mammary artery (IMA) and saphenous vein are the most commonly utilized conduits in CABG surgery and are still considered to be the gold standard by most surgeons. However, there is emerging evidence that use of bilateral IMAs is associated with significantly better long-term outcomes and the benefit increases with time from surgery. In spite of this incremental beneficiary effect, most surgeons are reluctant to use both IMAs, because it is technically more demanding, time-consuming and is associated with marginally higher sternal wound infection rates...
April 2015: International Journal of Surgery
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