ABSTRACT
Although sequential bypass with <i>in situ</i> arterial conduits (the left and right internal thoracic arteries; LITA and RITA, the right gastroepiploic artery; GEA) in coronary artery bypass grafting (CABG) is technically demanding, it is one of the most important procedures using a limited number of <i>in situ</i> arterial conduits to revascularize a wide area. In this report, we retrospectively investigated the clinical outcome of CABG with 4 or more distal anastomoses using only <i>in situ</i> arterial conduits. From December 1990 to May 1999, 62 patients underwent CABG with <i>in situ</i> arterial conduits, with at least one sequential bypass. There were 59 men and 3 women patients with mean age of 59.6 years (41 to 82 years). Mean postoperative follow-up period was 32 months (1 to 101 months). The total number of distal anastomoses was 4 (1 sequential bypass) in 54 patients, 4 (2 sequential bypasses) in 6 patients, 5 (1 sequential bypass) in 1 patient and 6 (3 sequential bypasses) in 1 patient. There were 5 emergency operations (8%), 37 patients (60%) had a history of myocardial infarction, 30 patients (48%) had diabetes mellitus and 6 patients (10%) had chronic renal failure and were on hemodialysis. Left ventricular ejection fraction was 40% or less in 15 patients (24%). There were no early deaths. Angiographic patency was satisfactory for each graft (sequential: individual, LITA 96.7%: 100%, RITA 100%: 100%, GEA 89.5%: 97.4%). Patency of a distal anastomoses of GEA was rather poorer than that of proximal (<i>p</i>=0.03). Three patients died during the follow-up period (all of them due to malignancy). The 5-year actuarial survival and cardiac event-free rate was 94.6% and 87.2%, respectively. In conclusion, although an indication of GEA sequential grafting needs further study, <i>in situ</i> arterial grafting with at least one sequential arterial conduit was associated with excellent results and achieved more complete revascularization with exclusive use of <i>in situ</i> arterial conduits in patients with diffuse coronary artery disease.
ABSTRACT
A 57-year-old man underwent subtotal graft replacement of the thoracic aorta for aneurysms of both the ascending and descending aorta. On the 20th post-operative day, pus was found to be draining from the sternotomy wound. The wound was opened and irrigated with 2% Povidoneiodine solution for a total of 3 months. Culture of the pus from the irrigation revealed <i>Staphylococcus epidermidis</i>. When there were no clinical indications of infection and wound cultures were negative, the necrotic sternum and surrounding tissue were debrided and an omental graft was placed in the cavity. Upon follow-up examination, the patient is doing well 10 months after the initial surgery.