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Bilateral internal thoracic artery

Giuseppe Santarpino, Lazlo Gazdag, Joachim Sirch, Ferdinand Vogt, Miroslaw Ledwon, Theodor Fischlein, Steffen Pfeiffer
Bilateral internal thoracic artery (BITA) grafting may be associated with a higher risk of postoperative deep sternal wound infection than monolateral internal thoracic artery grafting due to a limited blood supply to the thoracic chest wall. Because preliminary studies suggest negative pressure wound therapy (NPWT) may reduce the risk of infection, a retrospective chart review of 129 patients who underwent BITA between February 2003 and October 2014 was conducted. Of those, 21 patients received NPWT for 5 days immediately following surgery and the incisions of 108 patients were covered with a conventional gauze dressing...
December 2015: Ostomy/wound Management
Noora Rafeek, Rajeswaran Rangasami, Kamakshi Dhanraj, Santhosh Joseph
Juvenile giant fibroadenoma is a very rare breast disease affecting young girls of premenarche and adolescent ages. It is a benign fibroepithelial tumour characterised by stromal and epithelial proliferation that causes rapidly growing breast mass. Bilateral symmetrical involvement is extremely rare. In this article, we describe this entity in a girl aged 13 years who presented with bilateral gigantically enlarged breasts. Ultrasonography and MRI showed large, multilobulated masses involving both breasts entirely...
October 6, 2016: BMJ Case Reports
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
David Glineur, Cyrus E Kuschner, Juan B Grau
PURPOSE OF REVIEW: Bilateral internal thoracic arteries (BITAs) have demonstrated their superiority over all other types of graft in terms of patency and survival benefit. BITA implementation requires the surgeon's evaluation of the patient's coronary anatomy and demographics. There is no single ideal approach to BITA utilization, but instead a variety of configurations that can be implemented based on the patient characteristics. RECENT FINDINGS: This article details the advantages and disadvantages of several BITA configurations in the setting of left-sided myocardial revascularization and right-sided myocardial revascularization...
November 2016: Current Opinion in Cardiology
Juan M Vrancic, Fernando Piccinini, Mariano Camporrotondo, Juan C Espinoza, Juan I Camou, Francisco Nacinovich, Pablo Fernandez Oses, Daniel Navia
BACKGROUND: There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). METHODS: We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18...
September 19, 2016: Annals of Thoracic Surgery
Shin Yajima, Yasushi Tsutsumi, Osamu Monta, Hisazumi Uenaka, Hirokazu Ohashi
No abstract text is available yet for this article.
September 9, 2016: Journal of Cardiac Surgery
Dmitry Pevni, Benjamin Medalion, Rephael Mohr, Yanai Ben-Gal, Adam Laub, Avner Nevo, Amir Kramer, Yosef Paz, Nachum Nesher
BACKGROUND: Bilateral internal thoracic artery (BITA) grafting in patients with diabetes mellitus is controversial because of a higher risk for sternal infection. The purpose of this study is to compare the outcome of BITA grafting to that of single ITA (SITA) grafting in patients with diabetes. METHODS: Between 1996 and 2010, 964 diabetic patients with multivessel disease who underwent primary coronary artery bypass graft surgery with BITA were compared with 564 patients who underwent coronary artery bypass graft surgery with SITA and saphenous vein grafts...
September 1, 2016: Annals of Thoracic Surgery
Giuseppe Gatti, Luca Maschietto, Marco Morosin, Marco Russo, Bernardo Benussi, Gabriella Forti, Lorella Dreas, Gianfranco Sinagra, Aniello Pappalardo
BACKGROUND: Concerns about increased risk of postoperative complications, primarily deep sternal wound infection (DSWI), prevent liberal use of bilateral internal thoracic artery (BITA) grafting in women. Consequently, outcomes after routine BITA grafting remain largely unexplored in female gender. METHODS: Of 786 consecutive women with multivessel coronary disease who underwent isolated coronary bypass surgery at the authors' institution from 1999 throughout 2014, 477 (60...
August 14, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Antonella Petrillo, Roberta Fusco, Salvatore Filice, Vincenza Granata, Orlando Catalano, Paolo Vallone, Maurizio Di Bonito, Massimiliano D'Aiuto, Massimo Rinaldo, Immacolata Capasso, Mario Sansone
PURPOSE: To obtain breast vascular map and to assess correlation between predominant feeding vessel and tumor location with a semi-automatic method compared to conventional radiologic reading. METHODS: 148 malignant and 75 benign breast lesions were included. All patients underwent bilateral MR imaging. Written informed consent was obtained from the patients before MRI. The local ethics committee granted approval for this study. Semi-automatic breast vascular map and predominant vessel detection was performed on MRI, for each patient...
2016: PloS One
Samet Vasfi Kuvat, Ümit Taşkın, Kadir Yücebaş, Hasan Deniz Tansuker, Mehmet Faruk Oktay, Erol Kozanoğlu, Salih Aydın
External ear reconstruction is a controversial topic in reconstructive plastic surgery. Here, we prepared a pedicled biosynthetic flap for full-thickness, partial ear defects in rabbits. We operated on six adult female New Zealand rabbits weighing 3-4 kg. The dimensions of the lateral thoracic fasciocutaneous flap were 7 × 6 cm. The flap was elevated based on one of the bilaterally located internal thoracic arteries, which were dissected proximally. The pedicled flap was folded in two, and polypropylene mesh was sandwiched in the middle...
August 5, 2016: European Archives of Oto-rhino-laryngology
Nikolaos A Papakonstantinou, Nikolaos G Baikoussis
For over 40 years, the left internal thoracic artery has been used as the gold standard for myocardial revascularization and anastomosis over the left anterior descending artery due to its excellent patency rates. However, the right internal thoracic artery behaves in the same manner as the left, also having excellent long-term patency. Hence, no patient should be deprived of the benefits of total arterial revascularization allowed by the bilateral use of both internal thoracic arteries.
May 2016: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
Norihiko Ishikawa, Go Watanabe
The application for robot-assisted coronary surgery ranges from internal thoracic artery (ITA) harvesting with hand-sewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB), either on- or off-pump. The bilateral IMA can be harvested with the aid of a surgical robot and then multivessel bypass grafting can follow. Such robot-assisted minimally invasive direct coronary artery bypass grafting is called "ThoraCAB". Surgical robots cannot only endoscopically harvest the ITA but they can also anastomose the coronary artery in TECAB...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Keita Kikuchi
INTRODUCTION: We report our clinical results of off-pump minimally invasive coronary artery bypass grafting( MICS CABG) under direct vision as our initial experience. SURGERY: An 8-10 cm incision was made in the left 4-5th intercostal space (ICS). Bilateral internal thoracic artery (BITA) were harvested under direct vision with the use of 32 cm Harmonic scalpel through the surgical port. And the right lung is displaced by a tissue stabilizer via subxiphoid incision...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
David Glineur, Munir Boodhwani, Claude Hanet, Laurent de Kerchove, Emiliano Navarra, Parla Astarci, Philippe Noirhomme, Gebrine El Khoury
BACKGROUND: Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. METHODS AND RESULTS: We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency...
July 2016: Circulation. Cardiovascular Interventions
Andrea Perrotti, Amedeo Spina, Enrica Dorigo, Camille Durst, Djamel Kaili, Sidney Chocron
Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0...
July 1, 2016: Thoracic and Cardiovascular Surgeon
J Trent Magruder, Allen Young, Joshua C Grimm, John V Conte, Ashish S Shah, Kaushik Mandal, Christopher M Sciortino, Kenton J Zehr, Duke E Cameron, Joel Price
BACKGROUND: Despite evidence that bilateral internal thoracic arteries (ITAs) improve long-term survival after coronary artery bypass grafting (CABG), uptake of this technique remains low. We directly compared bilateral ITA graft configurations and examined long-term outcomes. METHODS: We reviewed 762 patients who underwent CABG using bilateral ITA grafts at our institution between 1997 and 2014. The outcomes were mortality and a composite revascularization end point defined as need for percutaneous coronary intervention or repeat CABG...
July 2016: Journal of Thoracic and Cardiovascular Surgery
Taichi Sakaguchi
Although a minithoracotomy approach has several advantages over a sternotomy approach in terms of superior cosmesis and faster recovery, coronary artery bypass grafting (CABG) via sternotomy has been the gold standard for revascularization in multivessel coronary artery disease. Recently, nonsternotomy approaches, including the minimally invasive cardiac surgery CABG (MICS-CABG) via small left thoracotomy, have emerged as safe, effective alternatives. Excellent clinical results have been reported including equivalent mid-term graft patency as compared with a sternotomy approach...
March 2016: Nihon Geka Gakkai Zasshi
Quentin Luzurier, Vincent Le Guillou, Marion Lottin, Thomas Vermeulin, Hélène Marini, Tristan Petel, Pierre Czernichow, Jean-Paul Bessou, Jacques Bénichou, Véronique Merle
BACKGROUND: Older age and the use of bilateral internal thoracic artery (ITA) grafting are both considered risk factors for surgical wound infection (SWI) after coronary artery bypass grafting (CABG). The 2014 European Guidelines recommend that bilateral ITA grafting should be considered in patients aged younger than 70 years. Our aim was to investigate interaction between age and the number of ITA grafts. METHODS: All patients aged 18 years and older who had undergone CABG with at least 1 ITA at Rouen University Hospital between 2001 and 2012 were selected...
October 2016: Annals of Thoracic Surgery
Umberto Benedetto, Massimo Caputo, Mustafa Zakkar, Alan Bryan, Gianni D Angelini
OBJECTIVE: Whether radial artery (RA) as third arterial conduit in addition to bilateral internal thoracic artery (BITA) is associated with better survival than saphenous vein (SV) remains undetermined. METHODS: Study population included a selected low-risk group of 275 subjects undergoing BITA grafting with RA as third arterial conduit (BITA+RA) and 489 undergoing BITA grafting with additional SV graft (BITA+SV). RA was considered only for target stenosis of at least 75%...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Giuseppe Gatti, Luca Maschietto, Bernardo Benussi, Lorella Dreas, Gabriella Forti, Gianfranco Sinagra, Aniello Pappalardo
Background The frequent need of immediate institution of cardiopulmonary bypass because of ischemia and increased risk of bleeding and longer duration of surgery limit the use of bilateral internal thoracic artery (BITA) grafting in urgency. Patients and Methods Of 4,525 consecutive patients with multivessel coronary artery disease who underwent isolated coronary bypass surgery at the authors' institution (1999-September 2015), 121 (2.7%) patients had an operation before the beginning of the next working day after decision to operate, which is the definition for emergency according to the European System for Cardiac Operative Risk Evaluation II...
May 13, 2016: Thoracic and Cardiovascular Surgeon
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