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Bilateral internal thoracic artery

Umberto Benedetto, Douglas G Altman, Stephen Gerry, Alastair Gray, Belinda Lees, Gianni D Angelini, Marcus Flather, David P Taggart
BACKGROUND: There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the ART patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short-term (in-hospital) and long-term outcomes by performing a post hoc analysis of the ART...
March 3, 2018: Journal of the American Heart Association
Hiroto Kitahara, Mackenzie McCrorey, Brooke Patel, Sarah Nisivaco, Husam H Balkhy
OBJECTIVE: Previous studies have shown that women carry a higher risk of morbidity and mortality after coronary artery bypass surgery. We investigated sex differences in risk factors and outcomes in our patients undergoing robotic beating heart connector totally endoscopic coronary artery bypass. METHODS: From July 2013 to April 2017, patients undergoing connector totally endoscopic coronary artery bypass were reviewed. We compared the outcomes of men versus women...
February 15, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Giuseppe Gatti, Miroslaw Ledwon, Laszlo Gazdag, Federica Cuomo, Aniello Pappalardo, Theodor Fischlein, Giuseppe Santarpino
Single-use, closed incision management (CIM) systems offer a practical means of delivering negative pressure wound therapy to patients. This prospective study evaluates the Prevena™ Therapy system in a cohort of coronary patients at high risk of deep sternal wound infection (DSWI). Fifty-three consecutive patients undergoing bilateral internal thoracic artery (BITA) grafting were preoperatively elected for CIM with the Prevena™ Therapy system, which was applied immediately after surgery. The actual rate of DSWI in these patients was compared with the expected risk of DSWI according to two scoring systems specifically created to predict either DSWI after BITA grafting (Gatti score) or major infections after cardiac surgery (Fowler score)...
February 19, 2018: Updates in Surgery
Thomas A Schwann, Robert H Habib, Amelia Wallace, David M Shahian, Sean O'Brien, Jeffery P Jacobs, John D Puskas, Paul A Kurlansky, Milo C Engoren, Robert F Tranbaugh, Mark R Bonnell
BACKGROUND: More than 90% of coronary artery bypass grafting (CABG) is performed with a single-arterial bypass graft (SABG), based on the left internal thoracic artery (ITA) with supplemental vein grafts. This practice, often justified by safety concerns with multiple-arterial grafting (MABG), defies evidence of improved late survival achieved with bilateral ITA (BITA-MABG) or left ITA plus radial artery (RA-MABG). We hypothesized that MABG and SABG are equally safe. METHODS: We analyzed The Society of Thoracic Surgeons National Database (2004 to 2015) to assess the operative safety of BITA-MABG (n = 73,054) and RA-MABG (n = 97,623) vs SABG (n = 1,334,511)...
February 13, 2018: Annals of Thoracic Surgery
Janet M C Ngu, Ming Hao Guo, David Glineur, Diem Tran, Fraser D Rubens
OBJECTIVES: There is growing interest in the use of bilateral internal thoracic arteries (BITAs) for myocardial revascularization. This study sought to compare the balance between early benefits and long-term outcomes of skeletonized or non-skeletonized conduits and to determine whether differences in outcomes are affected by other patient risk factors. METHODS: BITAs were used in 1504 cases with either SK or NSK conduits. Propensity matching was completed using 22 covariates identifying 441 pairs of patients...
February 13, 2018: European Journal of Cardio-thoracic Surgery
Umberto Benedetto, Douglas G Altman, Stephen Gerry, Alastair Gray, Belinda Lees, Marcus Flather, David P Taggart
BACKGROUND: The long-term effects of off-pump coronary artery bypass continue to be controversial because some studies have reported increased adverse event rates with off-pump coronary artery bypass when compared with on-pump coronary artery bypass. The Arterial Revascularization Trial compared survival after bilateral versus single internal thoracic artery grafting. The choice of off-pump coronary artery bypass versus on-pump coronary artery bypass was based on the surgeon's discretion...
December 23, 2017: Journal of Thoracic and Cardiovascular Surgery
Oren Lev-Ran, Dan Abrahamov, Nina Baram, Menachem Matsa, Yaron Ishai, Ohad Gabai, Yael Refaely, Mahmud Abu Salah, Gideon Sahar
Background Procurement of the internal thoracic artery risks ipsilateral phrenic nerve injury and elevated hemidiaphragm. Anatomical variations increase the risk on the right side. Patients receiving left-sided in-situ right internal thoracic artery configurations appear to be at greatest risk. Methods From 2014 to 2016, 432 patients undergoing left-sided in-situ bilateral internal thoracic artery grafting were grouped according to right internal thoracic artery configuration: retroaortic via transverse sinus (77%) or ante-aortic (23%); targets were the circumflex and left anterior descending artery territories, respectively...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
Michael Persson, Ulrik Sartipy
PURPOSE OF REVIEW: Several advances have been made in recent years to improve outcome for patients with coronary artery disease. One of the most debated topics regarding surgical treatment with coronary artery bypass grafting (CABG) is graft selection. This review aims to present the current status and scientific evidence for bilateral internal thoracic artery (BITA) grafting. RECENT FINDINGS: Observational studies and pooled analyses suggest that BITA grafting is associated with improved survival...
January 23, 2018: Current Cardiology Reports
Margot Den Hondt, Bart M Vanaudenaerde, Eric K Verbeken, Jan J Vranckx
OBJECTIVES: Prerequisites for successful trachea transplantation include the use of a biocompatible construct, submucosal vascularization and an epithelial covering. Implantation of non-epithelialized tracheal scaffolds may lead to stenosis. However, epithelial grafting or seeding can only be attempted onto a well-vascularized submucosal bed. Our aim was to investigate a method to prevent stenosis during prelamination of non-epithelialized, gently decellularized rabbit tracheae and to evaluate whether grafting of revascularized constructs with buccal mucosa is feasible...
January 15, 2018: Interactive Cardiovascular and Thoracic Surgery
Giuseppe Gatti, Laura Morra, Gianluca Castaldi, Luca Maschietto, Florida Gripshi, Enrico Fabris, Andrea Perkan, Bernardo Benussi, Gianfranco Sinagra, Aniello Pappalardo
OBJECTIVE: To support a rational use of preoperative intra-aortic balloon pump (IABP) in cardiac surgery. DESIGN: Retrospective, observational study. SETTING: Single university hospital. PARTICIPANTS: The study included 588 (mean age 68.5 ± 9.6 yr) consecutive patients who received IABP before cardiac surgery from 1999 to 2016. INTERVENTIONS: Coronary surgery was performed in 573 (97.4%) cases...
December 6, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Soichiro Kitamura
Prior to the 1970s, pediatric coronary artery bypass surgery (PCABS) was seldomly performed due to the lack of compelling surgical indications. The advent of coronary sequelae secondary to Kawasaki disease (KD) and the occurrence of coronary artery complications due to newly developed procedures, such as the arterial switch operation and early repair for intrinsic congenital coronary malformations, necessitated the development of PCABS. Because children grow rapidly and their life expectancy is very long, with increasing exercise capability requirements, the strategy for PCABS should differ from that for bypass surgery in adults...
2018: Proceedings of the Japan Academy. Series B, Physical and Biological Sciences
Christopher T Ryan, Alexander Schutz, Todd K Rosengart
No abstract text is available yet for this article.
January 6, 2018: Journal of the American Heart Association
Mario Gaudino, Antonino Di Franco, Mohamed Rahouma, Derrick Y Tam, Mario Iannaccone, Saswata Deb, Fabrizio D'Ascenzo, Ahmed A Abouarab, Leonard N Girardi, David P Taggart, Stephen E Fremes
BACKGROUND: Observational studies suggest a survival advantage with bilateral single internal thoracic artery (BITA) versus single internal thoracic artery grafting for coronary surgery, whereas this conclusion is not supported by randomized trials. We hypothesized that this inconsistency is attributed to unmeasured confounders intrinsic to observational studies. To test our hypothesis, we performed a meta-analysis of the observational literature comparing BITA and single internal thoracic artery, deriving incident rate ratio for mortality at end of follow-up and at 1 year...
January 6, 2018: Journal of the American Heart Association
Kirsteen R Burton, Noah Ditkofsky
The internal thoracic artery (ITA) is the largest thoracic wall artery and is clinically important primarily for use in coronary artery bypass grafting. A number of anatomic variants of the ITA have been reported; however, bilateral, aberrant lateral branches of the ITA never have. The importance of this finding lies in the positioning of the artery at a potential chest tube insertion site. Here, we report the identification, on CT scan, of this rare variation in a young male trauma patient.
January 4, 2018: BMJ Case Reports
Takaaki Maruhashi, Hiroaki Minehara, Ichiro Takeuchi, Yuichi Kataoka, Yasushi Asari
BACKGROUND: The resuscitative endovascular balloon occlusion of the aorta, because of its efficacy and feasibility, has been widely used in treating patients with severe torso trauma. However, complications developing around the site proximal to the occlusion by resuscitative endovascular balloon occlusion of the aorta have almost never been studied. CASE PRESENTATION: A 50-year-old Japanese woman fell from a height of approximately 10 m. At initial arrival, her respiratory rate was 24 breaths/minute, her blood oxygen saturation was 95% under 10 L/minute oxygenation, her pulse rate was 90 beats per minute, and her blood pressure was 180/120 mmHg...
December 14, 2017: Journal of Medical Case Reports
Emmanouel Papadakis, Maria Kalliopi Konstantinidou, Meletios A Kanakis
We herein present the unique case of a 68-year-old male diabetic patient who developed sterile necrosis of the sternum 1 month after myocardial revascularization with the use of bilateral internal thoracic artery grafts. The sternum had been closed by the bilateral Robicsek wiring technique. The sternum was removed, and bilateral pectoralis major flaps were used to cover the defect. The patient had an uneventful recovery.
December 2017: Korean Journal of Thoracic and Cardiovascular Surgery
Masami Ochi
In Kawasaki disease (KD), giant coronary aneurysms in the proximal segments of the coronary arteries have long been among the serious complications associated with acute myocardial infarction. To treat myocardial ischemia in children, Kitamura et al. first performed coronary artery bypass grafting in a pediatric patient using an autologous saphenous vein. In the early 1980s, they began to use the internal thoracic artery (ITA) as a bypass graft to the left anterior descending artery, which later was proven to improve long-term life expectancy with its favorable long-term patency, as well as growth potential...
March 2018: General Thoracic and Cardiovascular Surgery
Thomas A Schwann, James Tatoulis, John Puskas, Mark Bonnell, David Taggart, Paul Kurlansky, Jeffery P Jacobs, Vinod H Thourani, Sean O'Brien, Amelia Wallace, Milo C Engoren, Robert F Tranbaugh, Robert H Habib
Recent evidence shows that multi-arterial coronary artery bypass grafting (MABG) based on bilateral internal thoracic (BITA) or left internal thoracic (LITA) and radial artery (RA) improves long-term outcomes compared with single arterial coronary artery bypass grafting (SABG) (LITA + saphenous vein graft). How this evidence affected the worldwide use of MABG, if at all, is not well defined. Accordingly, we report 10-year temporal trends of MABG utilization from 2 continents. A study population of 1,683,434 non-emergent, primary, isolated LITA-based coronary artery bypass grafting (CABG) (≥2 grafts) patients was derived from the Society of Thoracic Surgeons (STS) (1,307,528 (79...
2017: Seminars in Thoracic and Cardiovascular Surgery
X J Luo, W Wang, Y T Wang, Y Yang, H Li, X Wang, S S Hu
Objective: To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery (DBLCFA) in the coronary artery bypass grafting (CABG) operation. Methods: Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography (CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47...
November 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Pradeep Nambiar, Sanjay Kumar, Chander Mohan Mittal, Kailash Saksena
OBJECTIVE: The aim was to show that total arterial revascularization via a left minithoracotomy using bilateral internal thoracic arteries was not only feasible but also a safe and reproducible procedure with excellent midterm outcomes. METHODS: From August 2011 to August 2016, 819 patients underwent off-pump minimally invasive multivessel coronary artery bypass grafting using bilateral internal thoracic arteries harvested through a 2-inch left minithoracotomy incision, and complete revascularization of the myocardium was performed using the left internal thoracic artery-right internal thoracic artery Y composite conduit...
January 2018: Journal of Thoracic and Cardiovascular Surgery
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