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@#Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.
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Objective:To report the use of right internal mammary artery (RIMA) in coronary artery bypass grafting (CABG) in our center, summarize the purpose and configuration of RIMA graft in CABG.Methods:All clinical data of coronary artery bypass grafting patients in our center performed in the past 6 years were collected and analyzed retrospectively. Those patients were divided into RIMA group and non-RIMA group according to the use of RIMA. Propensity score matching had been performed before these data was compared. Surgical technique of use of RIMA was summarized.Results:1 537 CABG had been performed from January 1st, 2016 to October 31st, 2021 in our center. Of which, 128 cases were allocated to RIMA group. After propensity score matching having been performed, there was no difference in baseline data between the RIMA group and the non-RIMA group (128 cases), and the RIMA group had more grafts and arterial grafts than the non-RIMA group. The postoperative drainage volume in the RIMA group was more than that of the non-RIMA group. However, there was no statistical significance in difference of transfusion between two groups. Also, there was no difference in postoperative mechanical ventilation time, ICU time and length of stay postoperatively. The postoperative complications were similar between two groups. Postoperative patency rate of the RIMA graft was as high as 95.2%. The target vessels of RIMA included left anterior descending branch (45 cases), diagonal branch (19 cases), intermediate branch (12 cases). obtuse marginal or circumflex branch (16 cases), posterior descending branch (5 cases) and right coronary trunk (18 cases). 41 RIMA used as free grafts, 87 used as in situ grafts, of which 19 RIMA need lengthened by other graft vessels.Conclusion:The patency rate of RIMA graft is high and the application of RIMA do not increase the surgical risk significantly. However, there are versatile contour of RIMA grafts. It can be used as artery graft in selected patients.
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@#Objective To investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA. Methods From July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed. Results A total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05). Conclusion Preoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.
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Objective:To compare the efficacy of Milrinone and Papaverine in relieving the spasm of internal mammary artery (LIMA) during off-pump coronary artery bypass grafting (OPCABG).Methods:Between April 2018 to December 2018, 200 patients who suffered obvious angina pectoris and three-vessel disease documented by coronary angiography, undergoing OPCABG at Beijing Anzhen Hospital, Capital Medical University were recruited in this study, including 103 males and 97 females, aged 46-74 years, with an average of (59.12±0.49) years old. For all patients, the LIMA was anastomosed to left anterior descending artery(LAD). According to different methods relieving LIMA spasm, all patients randomly divided into 4 groups (n=50): Papaverine surface infiltration group (group Ⅰ), Papaverine injection group (group Ⅱ), Milrinone surface infiltration group (group Ⅲ) and Milrinone injection group (group Ⅳ). The blood flow (ml/min) of the free LIMA, the blood flow of the LIMA-LAD after bypass, anastomotic time of obtuse marginal artery, the use of vasoactive drugs, the outcomes of perioperative period and 1 year after operation were compared in the four groups.Results:There was no significant difference between group Ⅲ and group Ⅰ in the blood flow of free LIMA and LIMA-LAD[(45.50±1.43)ml/min vs. (47.42±1.61)ml/min、(28.60±0.89)ml/min vs. (28.40±0.96)ml/min, all P>0.05]. The blood flow of free LIMA and the LIMA-LAD in group Ⅱ were significantly higher than those in group Ⅰ[(60.36±1.28)ml/min vs. (47.42±1.61)ml/min, (42.40±1.25)ml/min vs. (28.40±0.96)ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅲ[(70.86±2.00) ml/min vs. (45.50±1.43) ml/min, (59.46±1.25) ml/min vs. (28.60±0.89) ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅱ[(70.86±2.00) ml/min vs. (60.36±1.28) ml/min, (59.46±1.25) ml/min vs. (42.40±1.25)ml/min, all P<0.05]. The anastomotic time of obtuse marginal artery[(7.14±0.72)min vs. (8.30±0.93)min, (8.10±0.89)min, (8.14±0.90)min, P<0.05], the dopamine dose[(3.76±0.40)μg·kg -1·min -1 vs. (5.02±0.52)μg·kg -1·min -1, (4.84±0.48)μg·kg -1·min -1, (4.90±0.49)μg·kg -1·min -1,P<0.05] and the esmolol usage (32% vs. 60%, 58%, 58%, P<0.05) during the operation in group Ⅳ were significantly reduced compared with the other three groups. The V3 ST depression on the postoperative first day[(0.34±0.18)mv vs. (0.71±0.22)mv, (0.68±0.20)mv, (0.69±0.22) mv, P<0.05], and the TNI on the postoperative third day[(0.24±0.08)ng/ml vs. (0.56±0.15)ng/ml, (0.54±0.11)ng/ml, (0.53±0.12) ng/ml, P<0.05] were significantly lower in group Ⅳ than those in the other three groups. However, there was no significant difference about the first-year patency of LIMA-LAD among four groups. Conclusion:For relieving spasm of LIMA, the Milrinone injection was better than that of Papaverine, which could shorten the anastomotic time of obtuse marginal artery, maintain intraoperative hemodynamics stability, reduce myocardial damage during OPCABG.
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@#Objective To summarize the use of harmonic scalpel to harvest bilateral internal mammary artery in coronary artery bypass grafting (CABG). Methods The clinical data of 54 patients of bilateral skeletonized internal mammary artery harvesting for CABG in our hospital from January 2016 to May 2020 were analyzed retrospectively. There were 51 males and 3 females with a mean age of 62.37±9.56 years. Results All patients went through the procedure unevently and discharged from hospital. The number of grafts was 4.07±0.85 per patient, the operation time was 267.21±47.00 min, mechanical ventilation time was 342.43±132.17 min and hospital stay was 12.21±4.43 d. Conclusion It is safe and effective to use harmonic scalpel to harvest skeletonized bilateral internal mammary artery in CABG.
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Objective:To explore the influencing factors of postoperative graft stenosis in patients undergoing left internal mammary artery-left anterior descending branch (LIMA-LAD) coronary artery bypass graft (CABG) surgery.Methods:A retrospective analysis of the clinical data of 86 patients who were admitted to the Second Affiliated Hospital of Hainan Medical College and received coronary angiography after CABG surgery from July 2019 to December 2020 due to recurrent chest tightness, chest pain and other symptoms. According to the degree of stenosis of the LIMA-LAD graft, the patients were divided into stenosis group ( n=25) and non-stenosis group ( n=61). The graft stenosis of patients in the stenosis group was ≥50%, and the graft stenosis of patients in the non-stenotic group was less than 50%. The general information, past medical history, CABG intraoperative data, current visit data and biochemical indicators of the two groups were compared. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; count data comparison between groups was by Chi-square test. Logistic regression analysis was used to screen out the influencing factors of graft stenosis after CABG. Use the rms package in the R 4.0.2 software to build a nomogram prediction model. Using receiver operating characteristic (ROC) curve to evaluate the discriminative degree of the model. Use the calibration curve and deviation correction C-index to evaluate the nomogram prediction model. Use X-tile software to obtain the cutoff value of the nomogram model integral, use Kaplan-Meier method to draw the survival curve, and use Log-rank to test. Results:Logistic regression analysis showed that smoking, hypertension, pre-CABG left anterior descending branch (LAD) stenosis <75%, pre-CABG left internal mammary artery (LIMA) blood flow, and coronary angiography diffuse lesions are independent risk factors that affect LIMA-LAD graft stenosis after CABG ( P<0.05). The C-index value predicted by the nomogram model was 0.879 (95% CI: 0.818-0.955, P<0.001). The area under the ROC curve was 0.712 (95% CI: 0.594-0.801, P<0.001), with good discrimination. The calibration curve shows that the accuracy of the model prediction was good. Through the X-tile software screening to obtain the model score cutoff value, the patients were divided into low-risk group (≤54 points), medium-risk group (>54 points and ≤112 points), and high-risk group (>112 points). The results of survival analysis showed that the incidence of postoperative graft stenosis in the three groups was 20.9%, 50.0% and 80.0%, respectively. Conclusions:Smoking, hypertension, LAD stenosis before CABG <75%, LIMA blood flow before CABG, and coronary angiography diffuse lessions are independent risk factors that affect LIMA-LAD graft stenosis after CABG. The construction of a nomogram prediction model can provide a reference for evaluating the patency of the LIMA-LAD graft vessel before CABG operation, and reduce the probability of LIMA-LAD graft vessel stenosis after CABG operation.
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RESUMEN La arteria mamaria interna es el hemoducto de elección para injertar en la arteria coronaria descendente anterior. Un enorme cuerpo de evidencia demuestra que los resultados de la cirugía de revascularización miocárdica en el corto y largo plazo dependen de determinados factores relacionados con la preparación de la arteria, como su flujo y el grado de vascularización esternal residual. Por ese motivo, en las últimas décadas el procedimiento de disección de la arteria mamaria interna ha recibido tanta atención como la técnica de construcción de los injertos. Sin embargo, la historia de su origen y posterior evolución no ha sido siempre adecuadamente contada y muchas imprecisiones se han trasmitido a lo largo de los años.
ABSTRACT The left internal mammary artery is the conduit of choice for left anterior descending coronary artery grafting. A huge body of evidence shows that the short and long-term outcomes of coronary artery bypass grafting depend on specific factors related to the preparation of the artery, namely, its blood flow and residual sternal vascularization degree. Accordingly, the internal mammary artery harvesting has received as much attention as the grafting construction technique in recent decades. However, the story of its origins and subsequent progress has not always been properly told as many inaccuracies have been passed on over the years.
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Disección , Historia de la Medicina , Arterias Mamarias , Revascularización MiocárdicaRESUMEN
@#Objective To evaluate short-term clinical outcomes of skeletonized bilateral internal mammary artery (sBIMA) in coronary artery bypass grafting (CABG). Methods The clinical data of 62 patients (54 males and 8 females with an average age of 56.8±6.0 years) undergoing isolated CABG using sBIMA in our hospital from October 2016 to May 2017 were retrospectively analyzed. The coronary graft flow, perioperative clinical outcomes and CT results were reviewed. Results All the operations were carried out under extracorporeal circulation. Anastomosis of 124 internal mammary arteries was performed and 116 great saphenous veins were used simultaneously with an average anastomosis site of 4.5±0.8 for each patient. The cardiopulmonary bypass time was 116.4±22.9 min, aortic clamping time was 83.0±18.3 min, mechanical ventilation time was 20.8±21.3 h and ICU stay was 2.7±1.7 d. The graft flow of left internal mammary artery (LIMA), right internal mammary artery (RIMA) and great saphenous vein were 28.8±12.4 mL/min, 32.8±13.8 mL/min and 41.5±21.5 mL/min, respectively. There was no significant difference in the graft flow between LIMA and RIMA (P=0.112). There was no perioperative mortality, myocardial infarction or cerebrovascular accident. Only one male patient suffered sternal complication and poor wound healing and then received debridement as well as suturing. Coronary CT angiography showed that distal anastomosis of 7 vein grafts and 5 artery grafts was demonstrated shallow and 1 vein graft was undemonstrated, suggesting occlusion. Conclusion CABG with sBIMA is a safe and reliable technique with excellent early results.
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Abstract Objective: To analyze two techniques of papaverine application, topical spray on the harvested left internal mammary artery (LIMA) and perivascular injection, to find out their ability to improve LIMA flow. Methods: Forty patients were randomized into two groups. In Group 1, papaverine was sprayed on the harvested pedunculated LIMA. In Group 2, papaverine was delivered into the perivascular plane. Drug dosage was the same for both groups. LIMA flow was measured 20 minutes after applying papaverine. Blood flow was recorded for 20 seconds and flow per minute was calculated. The systemic mean pressures were maintained at 70 mmHg during blood collection. The data collected was statistically evaluated and interpreted. Results: The LIMA blood flow before papaverine application in the Group 1 was 51.9±13.40 ml/min and in Group 2 it was 55.1±15.70 ml/min. Statistically, LIMA flows were identical in both groups before papaverine application. The LIMA blood flow, post papaverine application, in Group 1 was 87.20±13.46 ml/min and in Group 2 it was 104.7±20.19 ml/min. The Group 2 flows were statistically higher than Group 1 flows. Conclusion: Papaverine delivery to LIMA by the perivascular injection method provided statistically significant higher flows when compared to the topical spray method. Hence, the perivascular delivery of papaverine is more efficient than the spray method in improving LIMA blood flow.
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Humanos , Arterias Mamarias , Papaverina , Vasodilatadores , InyeccionesRESUMEN
En los últimos 30 años se ha acrecentado el interés de los cirujanos cardiovasculares por la disección esqueletizada de la arteria mamaria interna, sobre todo estimulado por su empleo bilateral para lograr la revascularización arterial total en la mayor cantidad de pacientes; lo que, en teoría, se acompaña de una mayor incidencia de infecciones profundas de la herida esternal. Desde 1992, prácticamente no ha variado la técnica clásica de disección esqueletizada de la mamaria. Quizás los únicos cambios importantes han sido la introducción del cauterizador armónico alrededor del año 2000 y la tendencia de algunos escasos grupos de intentar conservar indemne el plexo venoso retroesternal. Después de un profundo análisis de los fundamentos históricos, anatómicos y fisiológicos sobre los que se sustenta este procedimiento, y basados en la práctica en más de 100 pacientes en un período de dos años, se presentan modificaciones a la técnica clásica de disección esqueletizada de la arteria mamaria interna que permiten la obtención de un hemoducto más saludable en menos tiempo, una mayor protección ante la infección y la isquemia del hueso y los órganos del mediastino, así como la conservación de la integridad de la vena mamaria interna
In the last 30 years the interest of the cardiovascular surgeons for the skeletonized dissection of the internal mammary artery has increased, mainly stimulated by its bilateral use, to achieve the total arterial revascularization in the greater amount of patients; this, in theory, is accompanied by a higher incidence of deep infections of the sternal wound. Since 1992, the classical technique of the mammary skeletonized dissection has practically not changed. Perhaps, the only major changes have been the introduction of the harmonic cauterizer around the year 2000 and the tendency of a few groups to try to preserve intact the retrosternal venous plexus. After a thorough analysis of the historical, anatomical and physiological fundaments on which this procedure is based, and based on the practice in more than 100 patients over a period of two years, modifications are presented for the classical technique of the skeletonized dissection of the internal mammary artery that allow obtaining a healthier hemoduct in less time, greater protection against infection and ischemia of the bone and mediastinal organs, as well as the preservation of the integrity of the internal mammary vein
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Revascularización Miocárdica , Flujo Sanguíneo Regional , Espasmo , Heparina , Profilaxis Antibiótica , Arterias MamariasRESUMEN
Introducción y objetivos: existe tendencia a procurar un aumento de los beneficios de la cirugía de revascularización mediante el uso de ambas arterias mamarias internas (DAMI). Nuestro objetivo fue analizar los resultados nacionales a largo plazo del uso de DAMI en una población de pacientes con ángor estable con indicación de revascularización aislada. Métodos: se recabaron los datos de pacientes operados desde 2006 a 2015 en Uruguay. Se extrajeron variables demográficas, operatorias y de seguimiento. Evaluamos mortalidad operatoria, mediastinitis y sobrevida. Estratificamos la población por edad en menor o mayor o igual a 65 años. Para disminuir la heterogeneidad entre grupos realizamos comparación mediante puntaje de propensión (PS) en menores de 65 años. Resultados: se incluyeron 2.791 pacientes. Los pacientes con DAMI eran más jóvenes (57,3?8,5 vs 65,9?8,6 años, p=0,001), con menor porcentaje de sexo femenino (15,6% vs 28,2%, p=0,001), menor incidencia de hipertensión (74,1% vs 79,8%, p=0,012) y menor Euroscore (1,35 vs 4,23, p=0,001). En ³65 años, DAMI resultó ser predictor independiente de mortalidad operatoria y peor sobrevida. En ?λτ;65 años pareados por PS, los pacientes con DAMI tuvieron mayor sobrevida, pero DAMI no fue predictor independiente para la misma. La revascularización completa en pacientes con una mamaria igualó la sobrevida a DAMI. La incidencia de mediastinitis fue similar en ambos grupos en todos los casos. Conclusiones: el uso de DAMI resultó perjudicial en pacientes 65 años. Dicha técnica ofrece mejores resultados en pacientes menores de 65 años, aunque su beneficio como predictor independiente parecería estar confundido por otras variables como la edad y la revascularización completa.
Introduction and objectives: there is a tendency to increase the benefits of surgery in coronary artery disease using both internal mammary arteries (BIMA). Our objective was to evaluate our long term national results in patients with stable coronary artery disease who receive isolated coronary artery bypass grafts (CABG) using BIMA. Methods: patients operated between 2006 and 2015 were included. Patients' demographic, operative and postoperative variables were extracted. The outcomes were operative mortality, deep sternal infection and survival. Our population was stratified by age in ?λτ; and ³ 65 years old. In order to decreased group heterogeneity, propensity match (PM) was performed. Results: 2.791 patients were included. Patients with BIMA were younger (57.3?8,5 vs 65,9?8,6 years old, p=0,001), lower incidence of females (15,6% vs 28,2%, p=0,001), of hypertension (74,1% vs 79,8%, p=0,012) and lower Euroscore (1,35 vs 4,23, p=0,001). In patients ³ 65 years old, BIMA was an independent predictor for worse operative mortality and survival. In PM patients ?λτ; 65 years old, BIMA was associated with improved survival but failed to be an independent predictor for it. Patients who received single internal mammary artery and had complete revascularization had similar survival to BIMA patients. Deep sternal infection was similar between groups in both strata. Conclusions: the use of BIMA was found to be an independent predictor for worse outcomes in patients ³ 65 years old. BIMA has better results for patients ?λτ; 65 years old although its independent benefit is confused by other variables such as age and complete revascularization.
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Humanos , Masculino , Cirugía Torácica , Arterias Mamarias/cirugía , Revascularización Miocárdica/mortalidad , Tasa de Supervivencia , Factores de Riesgo , Factores de EdadRESUMEN
Resumen Introducción: La cirugía de revascularización de miocardio (RVM) sigue siendo el gold standard en el tratamiento de la enfermedad coronaria multiarterial. Se ha demostrado que la RVM con ambas arterias mamarias internas (AMI) tiene mejor resultado de sobrevida a largo plazo. Metodología: Investigación retrospectiva de las cirugías de RVM con AMI bilateral, realizadas en el Instituto Nacional Cardiovascular-INCOR-EsSalud entre enero de 2012 a diciembre de 2015. Los objetivos fueron determinar la mortalidad por cualquier causa y los eventos cardiovasculares mayores a 30 días de seguimiento. Resultados: Treinta y seis pacientes fueron operados con AMI bilateral. No tuvimos mortalidad a 30 días. Los eventos cardiovasculares mayores se presentaron en el 5.56% de los pacientes (stroke 0%, infarto de miocardio posquirúrgico 5.56%, necesidad de nueva intervención coronaria 0%). La incidencia de mediastinitis y/o reconstrucción esternal fue de 0%. Siete pacientes tuvieron infección superficial de la herida, no hubo diferencia significativa entre los diabéticos y los no diabéticos (25% vs. 16.66%, OR: 3.3, p = 0.88) o entre los pacientes con o sin sobrepeso (19.23% vs. 20%, respectivamente, OR: 0.95, IC 95%, p = 0.68) para presentar infección de herida. Conclusiones: La RVM con AMI bilateral es un procedimiento seguro, con bajas tasas de mortalidad y de eventos cardiovasculares mayores a corto plazo. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Abstract Introduction: Coronary artery bypass graft (CABG) surgery remains the reference standard in the treatment of multivessel coronary disease. Several studies have shown that CABG with bilateral internal mammary arteries (BIMA) has better results in long-term survival. Methodology: A retrospective study was conducted on CABG surgeries with BIMA from January 2012 to December 2015 in the National Cardiovascular Institute, INCOR, EsSalud, Peru. The objectives were to determine the mortality and major cardiovascular events at 30 days followup. Results: Of the 36 patients subjected to CABG surgery with BIMA, the 30-day mortality was 0%, with major cardiovascular events occurring in 5.56% of patients (Stroke 0%, postoperative myocardial infarction 5.56%, need of new coronary intervention 0%). The incidence of mediastinitis and/or sternal reconstruction was 0%. Superficial wound infection was observed in 7 patients, with there being no significant difference between diabetics and non-diabetics (25% vs. 16.66%, OR = 3.3, P = .88), or between patients with or without overweight (19.23% vs. 20%, respectively,OR = .95; 95% CI, P = .68). Conclusions: CABG surgery with BIMA is a safe procedure, with low rates of mortality and major cardiovascular events in the short-term. © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Puente de Arteria Coronaria/métodos , Arterias Mamarias/trasplante , Factores de Tiempo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
<p><b>Background</b>Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.</p><p><b>Methods</b>From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.</p><p><b>Results</b>The average distal anastomosis was 2.34 ± 0.97 (range: 1-4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.</p><p><b>Conclusions</b>Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.</p>
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Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Angiografía Coronaria , Puente de Arteria Coronaria Off-Pump , Estudios de Seguimiento , Estudios Retrospectivos , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
@#Objective To evaluate the safety and efficacy of skeletonized and pedicled harvesting of bilateral internal mammary artery (BIMA) in coronary artery bypass graft (CABG) surgery. Methods From December 2015 to May 2017, 152 patients (128 males, 24 females, age of 56.5±6.8 years) underwent CABG using either skeletonized BIMA (s-BIMA group, n=73) or pedicled BIMA(p-BIMA group, n=79). The operative data and post-operative outcomes were analyzed in the s-BIMA group (61 males, 12 females, age of 56.6±7.0 years) and the p-BIMA group (67 males, 12 females, age of 56.3±6.7 years). Results There was no peri-operative mortality. There was no statistical difference in operative time, cardiopulmonary bypass time, aortic cross-clamp time or internal mammary artery graft flow between the two groups. One patient(1.4%) in the s-BIMA group suffered from severe sternal wound complication, which was major sternal wound complication. Five patients (6.3%) in the p-BIMA group suffered from sternal wound complications, including 1(1.3%) with severe complication and 4(5.1%) with minor complication. One(1.4%) patient in the s-BIMA group and 7 (8.9%) patients in the p-BIMA group suffered from chylothorax. The chest tube drainage significantly reduced in the s-BIMA group, both in postoperative day 1(P=0.000) and postoperative day 1-3 (P=0.001). CT angiography showed no stenosis of BIMA in both groups. Conclusion The use of skeletonized BIMA for CABG is safe and efficacious, with less sternal wound complications, chylothorax and chest tube drainage. Skeletonization should be suggested if BIMA is harvested in CABG.
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@#Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.
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Objective: To investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients. Methods: Between January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation. Results: All IMAP propeller flaps survived well, and the donor site healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching were relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment. Conclusion: IMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.
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Objective To investigate the clinical therapeutic methods and their curative effects in recurrent ischemic angina for internal mammary artery resterosis after coronary artery bypass grafting (CABG).Methods We enrolled the patients who had recurrence of ischemic angina for restenosis of internal mammary artery graft after CABG as research subjects in the Affiliated Hospital of Yan'an University from January 2014 to January 2016.The 42 patients were divided into three groups according to the different treatment approaches for recurrence of ischemic angina:Group A (n=22)who received internal mammary artery interventional therapy;Group B (n=12)who received coronary artery bypass grafting treatment;and Group C (n=8)who received left subclavian artery proximal stent treatment.Then we compared the clinical therapeutic effects in the three groups.Results The success rate in Group C was 100%,which was the highest in the three groups,and the post-operative restenosis rate was 0.The hospitalization time was significantly shorter in Group A than in Group B (P＜0.05).However,the two groups did not significantly differ in mortality,success rate or restenosis rate (P＞0.05).Conclusion We should select the appropriate treatment according to the patient's specific situation for recurrent ischemic angina. Endovascular treatment has evident therapeutic effects,rapid postoperative recovery,and lower treatment risk, making it the preferred treatment when possible.
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Objective To evaluate the value of different surgical methods in the repair of huge chest wall defect after breast malignant tumor operation.Methods The clinical data of 22 patients with chest wall defect after chest operation were retrospectively analyzed.All patients received one-stage repair for the chest wall defect with different surgical methods.Of the patients,9 cases got repair with latissimus dorsi myocutaneous flap,4 cases received repairment with internal mammary perforator flap of contralateral breast,and the others received dermatoplasty.Results All the 22 cases were successfully repaired.Two cases of dermatoplasty got mild edema who was healed after acitive dressing change.No one got effusion,infection or necrosis.No recurrence or distant metastasis happened except one case of liver metastasis in the follow-up of 6 to 24 months.Conclusions Application of different surgical methods in repair for the chest wall defect can improve patients' life quality.It is easy,safe and effective.We should choose the most suitable surgical method according to individual situation.
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Blood supply of mammary gland is extremely important, since it is a crucial factor in the mammary tissue development. The objective of this study was to describe and assess main mammary artery hemodynamic characteristics of lambs with two growth rates, using Doppler ultrasound. Two experimental groups, A and B, (n=10) of female Brazilian Bergamasca lambs were kept under the same management conditions and facilities. There were two phases: Phase 1, from 90 days of age until onset of puberty; Phase 2, from puberty until 1 year of age. During phase 1, a specific diet was formulated to each experimental group to obtain two different average daily gains: 150g, for treatment A, and 250g, for treatment B. During phase 2, there was no difference on the diet offered to both groups. Every 14 days, all animals were weighed and their body condition score was evaluated. Every 60 days, ultrasound exams (Doppler) of mammary artery were performed to obtain resistance and pulsatility indexes. Treatment B lambs showed higher weight gain and higher body condition score (P<0.05). However, for resistance and pulsatility indexes, there was no difference between treatments (P>0.05). Hemodynamic values remained constant, independent of diet or body development presented by the animals. Obtained data is valuable information on Bergamasca ewe lambs development.(AU)
O suprimento sanguíneo da glândula mamária é extremamente importante, uma vez que é um fator crucial para o desenvolvimento do tecido mamário. Assim, a necessidade de registro dos parâmetros de fluxo sanguíneo arterial é evidente. O objetivo do estudo foi descrever e avaliar as principais características hemodinâmicas da artéria mamária de cordeiras submetidas a diferentes taxas de crescimento, usando o ultrassom Doppler. Dois grupos experimentais, A e B, (n=10) de cordeiras da raça Bergamácia brasileira foram mantidas sob as mesmas condições de manejo e instalações. O estudo foi dividido em diferentes fases, sendo: Fase 1, de 90 dias de idade até o início da puberdade; Fase 2, desde a puberdade até 1 ano de idade. Durante a fase 1, dietas específicas foram formuladas para cada grupo experimental, a fim de obter duas médias diferentes de ganho de peso diário: 150g, para o tratamento A, e 250g, para o tratamento B. Durante a Fase 2, não houve diferença na dieta oferecida para os dois grupos. A cada 14 dias, todos os animais foram pesados e determinado o escore de condição corporal. A cada 60 dias, exames de ultrassom (Doppler) da artéria mamária foram realizados a fim de calcular os índices de resistência e pulsatilidade. As cordeiras do tratamento B registrou maior ganho de peso e escore de condição corporal (P<0,05). No entanto, não houve diferença para os índices de resistência e pulsatilidade entre os tratamentos (P>0,05). Os valores hemodinâmicos permaneceram constantes, independente da dieta ou o desenvolvimento do corpo apresentada pelos animais. Assim, os dados obtidos são informações valiosas sobre o desenvolvimento da raça a que se refere.(AU)
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Animales , Femenino , Diagnóstico por Imagen/veterinaria , Arterias Mamarias , Glándulas Mamarias Animales/irrigación sanguínea , Ovinos , Aumento de Peso , Ultrasonografía Doppler/veterinariaRESUMEN
Objective: To preliminarily analyze the graft flow of right internal mammary artery (RIMA) in patients after coronary artery bypass grafting (CABG) using bilateral internal mammary artery (BIMA). Methods: A total of 52 patients received CABG by BIMA in our hospital from 2015-12 to 2016-07 were studied. The patients were younger than 65 years at the mean age of (56.6±6.8) years including 46 male. According to conduit grafting to left anterior descending artery (LAD), the patients were divided into 2 groups: RIMA anastomosed to LAD group, n=42 and LIMA anastomosed to LAD group, n=10. The immediate graft flow was measured by Veri Q system, surgical outcomes and graft flows were compared between 2 groups. Results: There were no operative death in all 52 patients, 1 had poor wound healing and received debridement and suturing, no one had operative complication in left 51 patients. The average LAD bridge flow in both groups were (28.7±11.5) ml/min and (31.8± 11.7) ml/min, the mean pulsation index (PI) were (2.3±0.7) and (2.0±0.4), P>0.05; the average RIMA graft flow were (28.7±11.5) ml/min and (21.1±11.0) ml/min, the mean PI were (2.3±0.7) and (2.6±1.1), P>0.05. Conclusion: Flows in RIMA-LAD graft and LIMA-LAD graft were similar; the flow of RIMA anastomosed to other target vessel was satisfactory which was an ideal graft for CABG.