Patency of individual and sequential coronary artery bypass in patients with ischemic heart disease: a meta-analysis

Abstract Objective: To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease. Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data. Results: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%). Conclusion: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.

The predictive effects of clinical hematological changes on saphenous graft patency after coronary artery surgery

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

Intraoperative analysis of flow dynamics in arteriovenous composite y grafts

Abstract Objective: Composite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow. Methods: Revascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft. Results: Pharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow. Conclusion: Composite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.

Stent Compression in Iliac Vein Compression Syndrome Associated with Acute Ilio-Femoral Deep Vein Thrombosis

OBJECTIVE: This study was conducted to evaluate stent compression in iliac vein compression syndrome (IVCS) and to identify its association with stent patency. MATERIALS AND METHODS: Between May 2005 and June 2014, after stent placement for the treatment of IVCS with acute ilio-femoral deep vein thrombosis, follow-up CT venography was performed in 48 patients (35 women, 13 men; age range 23-87 years; median age 56 years). Using follow-up CT venography, the degree of the stent compression was calculated and used to divide patients into two groups. Possible factors associated with stent compression and patency were evaluated. The cumulative degree of stent compression and patency rate were analyzed. RESULTS: All of the stents used were laser-cut nitinol stents. The proportion of limbs showing significant stent compression was 33%. Fifty-six percent of limbs in the significant stent compression group developed stent occlusion. On the other hand, only 9% of limbs in the insignificant stent compression group developed stent occlusion. Significant stent compression was inversely correlated with stent patency (p < 0.001). The median patency period evaluated with Kaplan-Meier analysis was 20.0 months for patients with significant stent compression. Other factors including gender, age, and type of stent were not correlated with stent patency. Significant stent compression occurred most frequently (87.5%) at the upper end of the stent (ilio-caval junction). CONCLUSION: Significant compression of nitinol stents placed in IVCS highly affects stent patency. Therefore, in order to prevent stent compression in IVCS, nitinol stents with higher radial resistive force may be required.

Análise comparativa da perviedade das artérias torácicas internas na revascularização da região anterior do coração. Avaliação por angiotomografia no 6º mês de pós-operatório / Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation

Objetivo: Analisar a perviedade da artéria torácica interna direita pediculada, anteroaórtica em anastomose para o ramo interventricular anterior na revascularização do miocárdio, em relação à artéria torácica interna esquerda, com o uso de angiotomografia coronária, no 6º mês de pós-operatório. Métodos: No período de dezembro de 2008 a dezembro de 2011, 100 pacientes foram selecionados, prospectivamente, para cirurgia de revascularização do miocárdio sem circulação extracorpórea. Foram agrupados em Grupo-1 (G-1) e Grupo-2 (G-2), com 50 pacientes cada, randomização por computador e conhecimento da técnica no início da cirurgia. No G-1, os pacientes receberam artéria torácica interna esquerda para o ramo interventricular anterior e complementação da revascularização do miocárdio com a artéria torácica interna direita livre para ramos da circunflexa. Os pacientes do G-2 receberam artéria torácica interna direita pediculada para o ramo interventricular anterior e complementação da revascularização do miocárdio com artéria torácica interna esquerda, pediculada, para ramos da circunflexa. Resultados: Os grupos eram semelhantes quanto aos dados clínicos de pré-operatório. Houve predominância do sexo masculino, 75,6% e 88% nos grupos 1 e 2 respectivamente. Cinco pacientes migraram do G-1 para o G-2 devido à doença ateromatosa na aorta ascendente. A média de anastomoses distais no G-1 foi de 3,48 (DP=0,72), e no G-2 foi de 3,20 (DP=0,76). Os resultados das angiotomografias coronarianas em 96 pacientes reestudados mostraram que todas as artérias torácicas internas, direita ou esquerda, utilizadas pediculadas para a região anterior do coração encontravam-se ...

Objective: To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods: Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results: The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion: Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site. .

Comparação da perviedade entre artéria radial e veia safena em pacientes em pós-operatório de cirurgia de revascularização miocárdica com retorno dos sintomas / Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting post operative with return of the symptoms

OBJETIVO: Comparar a perviedade da artéria radial e veia safena em pacientes com retorno dos sintomas após cirurgia de revascularização do miocárdio (CRVM). MÉTODOS: Estudo retrospectivo. No período de janeiro de 1998 a dezembro de 2005, foram realizadas 469 CRVMs com o uso da artéria radial dentre os enxertos, no Hospital Vera Cruz, em Belo Horizonte/MG. Destes, 94 pacientes apresentaram alterações isquêmicas no pós-operatório recente ou tardio e foram reestudados com cineangiocoronariografia. Os enxertos foram divididos em três grupos: artéria torácica interna (ATI), artéria radial (AR) e veia safena (VS), e foram estratificados segundo a gravidade das lesões: sem lesão grave (<70 por cento), obstrução grave (70 por cento a 99 por cento) e oclusão. RESULTADOS: Nos 94 pacientes reestudados, foram utilizados 86 enxertos de ATI, 94 de AR e 111 de VS. Dos 86 enxertos de ATI, 73 (84,88 por cento) se encontravam sem lesões graves; dos 94 enxertos de AR eram 55 (58,51 por cento) e dos 111 enxertos de VS, 73 (65,76 por cento) estavam livre de lesões graves. Houve diferença estatística (P= 0,001) entre os enxertos de AR e VS com maior perviedade da VS. As mulheres apresentaram pior resultado quanto à perviedade da AR (65,7 por cento e 40,7 por cento) com P= 0,006. Quanto à artéria coronária revascularizada, houve diferença entre os enxertos usados para artéria coronária direita, com melhor resultado da VS (P= 0,036). CONCLUSÃO: A AR mostrou-se com pior resultado que a VS como segundo enxerto na CRVM, principalmente em mulheres e quando anastomosada na coronária direita.

OBJECTIVE: To compare the radial artery and saphenous vein's patency in patients with recurrence of symptoms in a coronary artery bypass grafting (CABG). METHODS: Retrospective study. From January 1998 to December 2005, 469 CABGs were performed using the radial artery as a graft, in Vera Cruz Hospital in Belo Horizonte/ MG. Among the patients who underwent those surgeries, 94 presented ischemic changes in early or late postoperative period, which led them to be re-evaluated by coronary angiography. The grafts were divided in three groups: internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV), and they were stratified according to the severity of injury: uninjured or patent (< 70 percent), severe obstruction (70 to 99 percent) and occlusion. RESULTS: For the 94 patients in the study, 86 grafts of ITA, 94 of RA and 111 of SV were used. For the 86 ITA grafts, 73 (84.88 percent) were found patent. For the 94 RA grafts, 55 (58.51 percent) were found patent, and for the 111 SV grafts, 73 (65.76 percent) were uninjured. A statistically significant difference (P= 0.001) was found between RA and SV grafts, with a higher patency found for VS graft. For the RA grafts, women presented a worse result concerning the RA patency (65.7 percent and 40.7 percent), with P = 0.006. Concerning coronary revascularization, a statistically significant difference was found only for the grafts used for the right coronary, with a better result for the SV (P = 0.036). CONCLUSION: Radial artery (RA) presented worse results when compared to Saphenous vein (SV) as a second graft in a CABG, especially in women who were anastomosed in the right coronary artery.

Análise angiográfica tardia dos enxertos empregados na revascularização miocárdica de pacientes com retorno de sintomas / CABG late angiographic grafting patency analysis in patients with recurrent symptoms

OBJETIVO: A Artéria Torácica Interna Esquerda (ATIE) é o padrão ouro como enxerto na revascularização miocárdica (RM). Para otimizar seu uso, e de outros enxertos, têm sido usadas anastomoses sequenciais. Não há consenso da equivalência dos resultados entre enxertos isolados e sequenciais. O objetivo é comparar a perviabilidade dos enxertos isolados versus sequenciais. MÉTODOS: Análise retrospectiva da patência dos enxertos empregados na RM por meio de cinecoronariografias realizadas no período entre janeiro/2000 e agosto/2007, em 88 pacientes com retorno de sintomas, operados em nosso serviço. Foi utilizado o teste t de Student para a análise estatística dos resultados. Cada anastomose distal foi considerada como um enxerto independente. RESULTADOS: O período médio de pós-operatório foi de 53 + 138 meses e a idade média foi de 64 + 11 anos. Os enxertos isolados de ATIE apresentaram patência superior aos dos enxertos sequenciais, sendo respectivamente de 92 por cento (46/50) e 77 por cento (30/39), com P = 0,02. Entretanto, em artérias coronárias com lesões > 70 por cento, a patência da ATIE isolada é semelhante à seqüencial, sendo, respectivamente, 95 por cento (37/39) e 93 por cento (26/ 28), com P = 0,37. A patência média de artéria radial para enxertos isolados e sequenciais foi, respectivamente, 71 por cento (5/ 7) e 90 por cento (19/21), com P = 0,10. A patência média da veia safena para enxertos isolados e sequenciais foi, respectivamente, 72 por cento (31/43) e 81 por cento (73/90), com P = 0,12. Não houve diferença entre a patência da artéria radial e da veia safena. CONCLUSÃO: Em pacientes com retorno dos sintomas, a ATIE isolada apresenta patência superior à sequencial. Entretanto, em lesões coronarianas > 70 por cento, a patência da ATIE isolada é semelhante à sequencial. Os enxertos sequenciais de artéria radial e de veia safena são semelhantes aos seus respectivos enxertos isolados.

OBJECTIVE: Left internal thoracic artery (LITA) grafting has become the gold standard in coronary artery bypass graft procedure (CABG). In order to optimize the use of LITA or other grats, sequential anastomosis has been used. There is no consensus on equivalence of results between isolated and sequential grafts. The aim of this study is to compare the patency of isolated versus sequential grafts. METHODS: From January 2000 to August 2007, a retrospective patency analysis of the grafts used in 88 symptomatic patients who underwent CABG procedure in our Service was performed through cinecoronariography. Statistical analysis was performed through Student's t test. Each distal anastomosis was considered an independent graft. RESULTS: The mean postoperative period was of 53 + 138 months and mean age was 64 + 11 years. LITA isolated grafts presented patency rate significantly higher than the sequential grafts, respectively 92 percent (46/50) and 77 percent (30/39) P = 0.02. However, in injured coronary arteries of > 70 percent, isolated LITA patency rate was similar to sequential grafts, (95 percent; 37/39) and (93 percent; 26/28) respectively; P = 0.37. Mean radial artery patency rate was similar to isolated 71 percent (5/7) and sequential 90 percent (19/21) grafts; P = 0.10. Saphenous vein patency rates were similar for isolated 72 percent (31/43) and sequential 81 percent (73/90) grafts; P = 0.12. There was no difference between radial artery and saphenous vein patency rates. CONCLUSION: In symptomatic patients, isolated LITA patency is superior than sequential LITA. However, in coronary injuries of > 70 percent, the isolated and sequential patency rates are similar. Sequential grafts from radial artery and saphenous vein are similar to their respective isolated grafts.

Revascularização miocárdica com artéria radial: influência da anastomose proximal na oclusão a médio e longo prazo / Coronary artery bypass grafting using the radial artery: influence of proximal anastomosis site in mid-term and long-term graft patency

OBJETIVO: Determinar se o local da anastomose proximal apresenta influência ou não na perviedade a médio e longo prazo destes enxertos. MÉTODOS: Foram reestudados 123 pacientes, de um total de 481 operados com artéria radial (AR). A média de idade era de 58,8 + 10,4 anos. Noventa e seis (78,05 por cento) pacientes foram operados com circulação extracorpórea (CEC). Considerando-se todos os enxertos, foram revascularizados 382 ramos coronários, média de 3,1 + 0,8 artérias por paciente. Desse total, 150 artérias foram revascularizadas com AR, sendo os ramos marginais esquerdos (ME) os mais prevalentes (48,67 por cento). A anastomose proximal foi realizada na aorta em 50 pacientes (40,65 por cento) e em "Y" com a artéria torácica interna esquerda (ATIE) ou direita (ATID) nos demais 73 (59,35 por cento). No pós-operatório, os reestudos angiográficos tiveram período médio de 5,36 + 3,21 anos. Os dados foram divididos em duas categorias: anastomose proximal (aorta/"Y") e perviedade (enxerto ocluído/pérvio). Foi utilizado teste qui-quadrado para duas proporções, com intervalo de confiança (IC) de 95 por cento. RESULTADOS: Dos 50 enxertos com anastomose na aorta, 42 (84 por cento) apresentaram-se pérvios, contra oito (16 por cento) ocluídos. Dos 73 enxertos em "Y", 59 (80,82 por cento) apresentaram-se pérvios, contra 14 (19,18 por cento) ocluídos. Comparando-se enxertos ocluídos e pérvios de ambas as técnicas, observou-se não haver diferença estatisticamente significativa entre as proporções (P=0,651, IC=95 por cento). CONCLUSÃO: Conclui-se que, na utilização da AR como enxerto coronário, o local da anastomose proximal não interfere na obstrução e no fluxo do enxerto, a médio e longo prazo.

OBJECTIVE: To determine whether the proximal anastomosis interferes or not in mid- and long-term patency of these grafts. METHODS: One hundred twenty-three out of 481 patients who had undergone surgery using radial artery (RA) were restudied. The mean age was 58.8 + 10.4 years. In 96 (78.05 percent) patients the cardiopulmonary bypass (CPB) was used. Considering all surgical grafts, 382 coronary branches were grafted (mean, 3.1 + 0.8 arteries per patient). 150 of them used radial artery (RA), and the left marginal branches (LOM) were the most prevalent (48.67 percent). The proximal anastomosis was performed in the aorta in 50 (40.65 percent) patients and as an artificial "Y" composite graft with the left or right internal thoracic artery (LIMA/RITA) in 73 (59.35 percent). Postoperatively, coronary angiography studies were performed within a mean period of 5.36 + 3.21 years. The obtained data was divided into two categories: proximal anastomosis (aorta/composite) and patency (occluded/patent). A chi-square test was used to compare both proportions, within a 95 percent confidence interval (CI). RESULTS: From the 50 aorta-anastomosed grafts, 42 (84 percent) were patent and eight (16 percent) occluded. Regarding the 73 "Y" composite grafts, 59 (80.82 percent) were patent and 14 (19.18 percent) occluded. Comparing these proportions in both techniques, there was no statistically significant difference between them (P=0.651, CI=95 percent). CONCLUSION: The site of proximal anastomosis of the RA coronary grafts does not interfere in mid- and long-term graft occlusion and patency.

Nova técnica cirúrgica de preparo da veia safena para revascularização do miocárdio sem manipulação direta - no-touch / Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting

FUNDAMENTO: Otimização da veia safena na revascularização miocárdica. OBJETIVO: Apresentar a técnica no-touch de preparo da veia safena. Essa técnica consiste na retirada da veia safena do seu leito, com um pedículo de tecido adiposo, protegendo-a contra espasmos, sendo desnecessário distendê-la. MÉTODOS: Estudo prospectivo e randomizado, incluindo 156 pacientes submetidos a cirurgia de revascularização miocárdica. Comparação da técnica no-touch com duas outras técnicas: convencional e intermediária. Procedeu-se à avaliação da morfologia endotelial, utilizando a microscopia. A perviabilidade das pontes foi determinada com exame angiográfico num período médio de 18 meses após a operação. A enzima óxido nítrico sintetase endotelial (eNOS) foi identificada por meio do estudo imunohistoquímico. RESULTADOS: A avaliação morfológica mostrou integridade endotelial de 97 por cento nas veias do grupo no-touch; enquanto quase metade da superfície endotelial das veias tratadas pelas outras técnicas exibiu ausência de células endoteliais. A angiografia revelou perviabilidade de 95,4 por cento para as pontes do grupo no-touch, 88,9 e 86,2 por cento para as pontes do grupo convencional e intermediária, respectivamente. O estudo imunohistoquímico revelou a presença da eNOS nas três camadas que compõem a parede da veia no grupo no-touch e redução dessa enzima no grupo convencional. CONCLUSÃO: A integridade endotelial e a atividade da eNOS foram melhor preservadas com o uso da técnica no-touch. A proteção mecânica fornecida pelo tecido gorduroso circundante à veia e a atividade vasodilatadora e bloqueadora da agregação plaquetária causada pelo óxido nítrico podem ser responsáveis pela proteção da veia contra o espasmo, como também por sua alta perviabilidade imediata.

BACKGROUND: Optimization of the saphenous vein for myocardial revascularization. OBJECTIVE: To present the no-touch technique of the saphenous vein preparation. This technique consists of harvesting the vein with a pedicle of surrounding tissue, which protects the vein from spasms, obviating the need for distension. METHODS: A prospective, randomized study with 156 patients who underwent artery bypass grafting was performed comparing three saphenous vein harvesting techniques: conventional, intermediate, and no-touch. A morphological study of the endothelium was carried out using scanning microscopy. An angiographic assessment of the vein graft patency was performed at a mean follow-up time of 18 months. Also, an immunohistochemical assessment was carried out to identify the endothelial enzyme nitric oxide synthase (eNOS) in the vein wall RESULTS: The preservation of the endothelial cell integrity was greater in the no-touch technique than in the other procedures. At angiographic follow-up, the patency for the no-touch group was 95.4 percent, 88.9 percent for the grafts of the conventional technique group, and 86.2 percent for the grafts performed in the intermediate technique group. The immunohistochemical assessment revealed eNOS in all three layers of the vein wall in the no-touch group and reduction of this enzyme in the conventional group. CONCLUSION: The endothelial integrity and eNOS activity were better preserved when using the no-touch technique for vein graft harvesting. The mechanical protection provided by the cushion of surrounding tissue in the no-touch group, the vasorelaxation and thromboresistant activities of nitric oxide may be responsible for the reduction of vasospasms and improved patency rate.

Internal thoracic artery graft (ITAG): patency and functional status at rest and during dobutamine-stress echocardiography / Artéria torácica interna enxertada: patência e estado funcional em repouso e após dobutamina

FUNDAMENTO: A artéria torácica interna enxertada (ATIE) patente usualmente tem fração diastólica (FD)> 50 por cento do fluxo. O estado funcional pode ser avaliado pelo índice de reserva coronariano (IRC). OBJETIVO: Avaliar, pela ecocardiografia e pelo Doppler em nível supraclavicular, a patência e o estado funcional da ATIE. MÉTODOS: Foram coletados prospectivamente e analisados os dados de 66 pacientes submetidos a ecocardiograma sob estresse com dobutamina (EED). O grupo I (GI) ocorreu com 49 ATIE sem estenose. No grupo II (GII) (10 ATIE) havia estenose significativa (> 50 por cento e <100 por cento). E no grupo III (GIII) (7 ATIE) a oclusão era de 100 por cento. Foram avaliados diâmetros e espectros do Doppler das ATIE no repouso e EED. RESULTADOS: Considerando patência uma FD>50 por cento, ocorreu em 49 ATIE (GI=40, GII=8 e GIII=1) no repouso e em 61 ATIE (GI=49, GII=10 e GIII=2) durante EED. Sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia foram, respectivamente, em repouso, 81 por cento, 86 por cento ,98 por cento, 35 por cento e 82 por cento; e no EED, 100 por cento, 71 por cento, 97 por cento, 100 por cento e 97 por cento. As ATIE com FD>50 por cento em repouso estavam patentes e as com FD<50 por cento no EED tinham oclusão total. Considerando para bom estado funcional um IRC>1,8, isso ocorreu em 42 ATIE (39 do GI, 2 do GII e 1 GIII), verificando-se sensibilidade = 79 por cento; especificidade = 85,7 por cento; VPP = 94 por cento; VPN = 59 por cento; e acurácia = 80,9 por cento. O IRC no GI foi maior (p=0,02) que em GII e GIII. CONCLUSÃO: Em nosso estudo, a avaliação não-invasiva da ATIE foi efetiva para verificar patência e estado funcional.

BACKGROUND: The patent internal thoracic artery graft (ITAG) usually has a diastolic fraction (DF) > 50 percent of the flow. The functional assessment can be evaluated by the coronary reserve index (CRI). OBJECTIVE: The objective was to evaluate the patency and functional status of the ITAG through echocardiography and Doppler. METHODS: Data from sixty-six patients who underwent dobutamine-stress echocardiography (DSE) were prospectively collected and analyzed. Group I (GI) had 49 ITAG without stenosis, Group II (GII), 10 ITAG with significant stenosis (> 50 percent and <100 percent) and Group III (GIII) had 7 ITAG with total occlusion. Diameters and Doppler spectrums from the ITAG at rest and during DSE were evaluated. RESULTS: Considering patency a DF >50 percent, it was observed in 49 ITAG (GI= 40, GII= 8 and GIII= 1) at rest and in 61 ITAG (GI=49, GII=10 and GIII=2) during DSE. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were respectively, 81 percent, 86 percent, 98 percent, 35 percent and 82 percent, and 100 percent, at rest and 71 percent, 97 percent, 100 percent and 97 percent in the DSE. The ITAG with DF>50 percent at rest were patent and the ones with DF<50 percent in the DSE presented total occlusion. Considering a CRI>1.8 for a good functional status, it was observed in 42 ITAG (39 from GI, 2 from GII and 1 from GIII), determining sensitivity=79 percent, specificity=85.7 percent, PPV=94 percent, NPV=59 percent and accuracy= 80.9 percent. The CRI in GI was higher (p= 0.02) than in GII or GIII. CONCLUSION: In our study, the non-invasive assessment of the ITAG was effective to verify the patency and the functional status.

Clinical evaluation of new balloon mountable coil stent: in-hospital and follow-up results.

The purpose of this study was to determine the feasibility, safety and efficacy of elective deployment of a new coil-stent (KR stent) in patients with coronary artery disease. KR stent deployment was attempted in 100 patients (135 lesions) enrolled prospectively at a single centre from December 1996 to March 1997. Ten, 15, 18, 24, and 32 mm long KR stents were manually crimped onto balloons and deployed in native coronary artery lesions. Majority of the patients had recent acute coronary syndromes (unstable angina 30% and post-myocardial infarction angina 56%). Diabetes was present in 34 percent of the patients. Fifty-six percent had single-vessel and 44 percent multi-vessel disease. In 38 percent, the lesions were located in proximal segments and 40 percent of lesions were long. KR stents were successfully deployed in 98 percent of patients. Mean minimal luminal diameter increased by 2.89 +/- 0.63 mm (from 0.57 +/- 0.38 mm before to 3.45 +/- 0.56 mm after the procedure). Mean percent diameter stenosis decreased from 83.33 +/- 10.84 percent before to 3.38 +/- 5.74 percent after the stent deployment. Mean reference vessel diameter was 3.45 +/- 0.56 mm. There were occasional technical complications including balloon rupture (1), stent migration (2) and distal embolisation of atheromatous material (1). One patient developed subacute stent thrombosis. There were no other major in-hospital cardiovascular events. At the end of six-month follow-up, there were no myocardial infarction or death. Six patients presented with recurrence of symptoms within six-months of the procedure, four of whom underwent target vessel revascularisation procedure. In conclusion, the in-hospital and six-month follow-up clinical results were highly encouraging with KR stent. Successful deployment rates were high despite unfavourable clinical and angiographic background. Low clinical events on follow-up will make it suitable for elective stenting.

Evolução hospitalar de pacientes com infarto de ventrículo direito e a importância da perviabilidade da artéria coronária direita / In-Hospital Outcome of Patients with Righ Ventricular Infarction and the Role of Right Coronary Artery Patency

PURPOSE--To evaluate the importance of the right coronary artery (RCA) patency in patients with right ventricular infarction. METHODS--Fifty-two patients with inferior wall myocardial infarction and right ventricular involvement were studied and divided in two groups: group A (GA) included 35 patients in whom the RCA was patent at coronary angiography, and group B (GB), 17 who had an occluded RCA. They were prospectively evaluated for electrical and hemodynamic complications, as well as in-hospital mortality. RESULTS--The mortality in GA was 11 and 29 in GB, p = 0.13; electrical complications were 11 in GA and 35 in GB, p = 0.06; hemodynamic complications were 8 in GA and 41 in GB, p = 0.009. CONCLUSION--These findings suggest a trend towards reduction in mortality and electrical complications, and significant reduction of hemodynamic complications in patients with inferior wall myocardial infarction with involvement of the right ventricle who have the RCA patent. Thus, RCA patency appears to be important in determining in-hospital outcomes of these patients.