Complete Arterial Revascularization Research Articles

Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery-Comparison of the Great Saphenous Vein with the Radial Artery.

Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac-cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan-Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.

Impact of transit-time flow measurement on early postoperative outcomes in total arterial coronary revascularization with internal thoracic arteries: a propensity score analysis on 910 patients.

The aim of this study was to evaluate the impact of transit-time flow measurement (TTFM) on early postoperative outcomes in total arterial coronary revascularization. A single-centre retrospective analysis was conducted on 910 patients undergoing isolated total arterial coronary artery bypass grafting with internal thoracic arteries (ITAs) at our institution, between January 2017 and February 2020. Complete arterial revascularization with bilateral ITAs with a Y-configuration, or single ITA, was planned for all patients. According to the surgeon preference, TTFM was assessed in 430 patients (TTFM group). They were compared with 480 patients without TTFM assessment (no TTFM group). Primary end point was the occurrence of in-hospital major cardiac adverse events (MACE). A propensity score analysis with an inverse probability weighting approach was performed to control for selection bias. TTFM was associated with longer cardiopulmonary bypass times (76.0 [62.0; 91.2] vs 79.0 [65.0; 94.0] min, P = 0.042). Six (1.4%) patients in the TTFM group versus no patient in the no TTFM group underwent intraoperative graft revision because of unsatisfying flow values (P = 0.011). MACE were significantly lower in the TTFM group (14, 3.3%) than in the no TTFM group (33, 6.9%, P = 0.014). At crude regression, TTFM was protective against MACE occurrence (odds ratios 0.46, 95% confidence interval 0.23-0.85, P = 0.016). Inverse probability weighting adjustment did not significantly displace P-values and odds ratios for MACE occurrence in the TTFM group 0.44, 95% confidence interval 0.28-0.69, P < 0.001. Even if associated with longer cardiopulmonary bypass times, intraoperative graft flow measurement with TTFM reduces MACE occurrence and it should be recommended for graft evaluation in arterial coronary artery bypass grafting surgery.

A Novel Subxiphoid Approach for Bilateral Internal Thoracic Artery Harvesting.

Bilateral internal thoracic artery (BITA) bypass can enable more complete arterial revascularization procedures. Minimally invasive cardiac surgery (MICS) can offer significant patient benefits. New minimally invasive technology for sternal retraction and tissue manipulation is needed to enable ergonomic and reliable minimally invasive ITA harvesting. The goal of this research was to develop technology and techniques, along with experimental testing and training models, for a sternal-sparing approach to in situ BITA harvesting through a small subxiphoid access site. This study focused on optimizing custom equipment and methods for subxiphoid BITA harvesting initially in a porcine model (19 pig carcasses, 36 ITAs) and subsequently in 7 cadavers (14 ITAs). Fifty consecutive ITAs were successfully harvested using this remote access approach. The last 20 ITA specimens harvested from the porcine model were explanted and measured; the average length of the free ITA grafts was 12.8 ± 0.9 cm (range 10.8 to 14.2 cm) with a mean time of 23.3 ± 5.2 minutes (range 13 to 25 minutes) for each harvest. Early results demonstrate that both ITAs can be reliably harvested in a skeletonized fashion in situ through sternal-sparing, small subxiphoid access in 2 experimental models. This innovative approach warrants further exploration toward facilitating complete arterial revascularization and the further adoption of minimally invasive coronary artery bypass graft surgery.

Anaortic Off-Pump Complete Arterial Revascularization Using Composite LIMA RIMA Y Sequential 5 Grafts in a Patient with Triple Vessel Disease Performed in a Low Resource Country: A Case Report

The use of bilateral internal thoracic arteries to treat coronary artery disease is very less despite of improved long-term survival. In this case report, a patient presented with TVD has been managed with anaortic off-pump complete arterial revascularization (OPCABG) by using composite LIMA RIMA Y Sequential 5 grafts to achieve complete arterial revascularization successfully. This type of operative procedure is technically difficult in a resource poor country like Bangladesh. However, this has been done by a group of young cardiac surgeon. During follow up, the patient is in a good condition.

Early Outcomes of Using Radial Artery in Coronary Artery Bypass Surgery in Cairo University Hospitals

Background: Using arterial grafts is commonly associated with good outcome. Using left internal mammary artery and radial artery can achieve complete arterial revascularization of left coronary system by using sequential grafting or multiple Y Technique. Objective: We present our experience in using internal mammary artery and radial artery (RA) Y-graft in 100 patients. Patients and Methods: Between February 2016 and January 2019, 100 patients (aged 45-60 years) with the diagnosis of multi-vessel disease underwent complete arterial revascularization using left internal mammary artery (LIMA) and RA. We used the technique of RA (Y) or (T) graft on LIMA to revascularize left coronary system; we did multiple (Y) or (T) graft or sequential grafts. Results The operating time was 220±20 minutes in average, the bypass time was (92.5 ± 16.7) minutes, and cross-clamp time was (70.6 ± 20.6 minutes). LIMA was anastomosed to the left anterior descending coronary artery (LAD) system in all patients. RA Y-graft was anastomosed to LIMA in all patients. Sequential grating using RA was done in 20 patients. The mean ICU stay of the patients was (2.2 ± 0.5 days). Mean hours of mechanical ventilation was (14.3 ± 2.9). Four patients required re-exploration for bleeding. 66 patients needed blood transfusion. 45 patients required inotropes. Conclusions: RA can be used safely with LIMA to revascularize left coronary territory using sequential grafts or multiple (Y) grafts. This method allows for complete arterial grafting in multi-vessel disease using only single IMA and RA grafts with good early results.

Transient time flow measurement in total arterial coronary revascularisation with internal thoracic arteries. Three years’ experience in 433 patients

Intraoperative graft flow measurement in coronary artery bypass grafting (CABG) is recommended, but its clinical impact is still controversial. We evaluated the effect of Transient Time Flow Measurement (TTFM) on Major Cardiac Adverse Events (MACE) in CABG surgery. Between January 2017 and February 2020, 959 patients underwent total arterial CABG with internal thoracic arteries (ITAs). Thirty-four patients with critical preoperative status according Euroscore II definition or redo procedures were excluded from the analysis. According to the surgeon preference, TTFM were assessed in 433 patients (TTFM) with Medistim system ( Fig. 1 ). They were compared with 492 patients without TTFM assessment (No TTFM). Complete arterial revascularisation with single or bilateral ITAs with a Y-configuration was planned for all patients. Patients’ data were extracted from the French Society of Thoracic and Cardiovascular Surgery database (EPICARD). Primary end-point was the occurrence of MACE, including in-hospital cardiac mortality, perioperative myocardial infarction, cardiac arrest and the need for extra-corporeal membrane oxygenation (ECMO). Preoperative characteristics, operative data and postoperative outcomes are resumed in Table 1 . TTFM is associated with longer cardio-pulmonary bypass (CPB) times, because of supplementary time needed for measurement (82 ± 24 vs. 78 ± 25 min., P = 0.023). Five patients in TTFM group underwent graft revision because of unsatisfying flow values. MACE were significantly lower in TTFM group (2.1% vs. 5.7%, P < 0.01). At multivariate analysis, TTFM was protective against MACE occurrence (OR 0.353, 95% CI 0.146–0.770, P = 0.013). Other independent risk factors for MACE occurrence were cross clamp time (OR 1.18, 95% CI 1.03–1.35, P = 0.016) and Euroscore II (OR 1.21, 95% CI 1.13–1.29, P < 0.001). TTFM reduces MACE occurrence and it should be mandatory for graft evaluation in coronary artery surgery.

Minimally Invasive Multiple Coronary Artery Bypass Grafting with Composite Graft Using in situ Right Gastroepiploic and Radial Arteries.

Minimally invasive surgery/coronary artery bypass grafting (MICS CABG) via left thoracotomy and multiple CABG is a reported alternative to the standard sternotomy approach. However, harvesting the right internal thoracic artery (RITA) under direct vision requires high surgical skill. We describe MICS CABG with the left internal thoracic artery (LITA) and a composite graft using the in situ right gastroepiploic artery (GEA) and radial artery (RA) to achieve complete coronary revascularization. No complications occurred, and postoperative computed tomography showed patency of all grafts. Our experience suggests that this composite graft can be used safely and effectively in MICS CABG for complete arterial revascularization without difficulty.

Usefulness of Radial Artery as a Carotid Artery Patch in Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Graft Operation with Complete Arterial Revascularization.

Serious coronary artery diseases including left main coronary artery disease, proximal left anterior descending artery disease, and three-vessel coronary artery disease with carotid artery stenosis are required simultaneous operations. By using complete arterial revascularization technique for coronary artery bypass graft operation, radial artery can be used safely as a patch material for carotid endarterectomy in combined surgery. Between 2016 and 2018, 14 patients who had serious coronary artery disease with the stenosis of unilateral carotid artery equal/over 70% were included in the study. Complete arterial revascularization was performed in all patients and radial artery was used as a patch material in carotid endarterectomy. All patients were discharged without any complication and carotid artery colored Doppler ultrasound was performed to the patients in the 3rd months, 6th months, and first year of the operation. There was no restenosis detected. In conclusion, radial artery is useable for carotid patch angioplasty in patients who underwent simultaneous carotid endarterectomy and coronary artery bypass graft operation with complete arterial revascularization. Further studies including a large number of patients are needed to examine the long-term patency of this graft.

OPERATIVE TECHNIQUES AND APPROACHES IN COMPLETE ARTERIAL REVASCULARIZATION IN MULTIVESSEL CORONARY ARTERY DISEASE. Review

Relevance. Multi arterial bypass surgery comprises nearly 10% of the overall operations for ischemic heart disease. Multiple studies proved the superiority of arterial grafts for multivessel coronary artery disease. Nevertheless, the vast majority of conduits utilized for multiple bypasses are saphenous vein grafts. With the increasing popularity of radial artery utilization, the gastroepiploic artery remains a faded option. So more studies should be conducted for evaluation of the benefits from the gastroepiploic artery in the setting of multi-arterial revascularization.&#x0D; Objective. Presentation of approaches and operative techniques for complete arterial revascularization in patients with multivessel coronary artery disease.&#x0D; Methods. Analytical review of literature on keywords in international scientometric databases Pub Med, Scopus, Web of Science. Search depth 12 years: from 2007 to 2018.&#x0D; Results. The current paper presents operative techniques and approaches to complete arterial revascularization in patients with multivessel coronary artery disease. The internal mammary artery remains the “gold standard” for the left anterior descending artery anastomosis site. Multiple arterial grafting is superior in terms of overall and cardiac survival. Emerging evidence of radial artery high term patency suggests the use of this arterial graft. Bilateral internal artery utilization provides long-term survival. Supplemental radial artery grafting to bilateral internal mammary provides complete arterial revascularization and can be safely used in routine cardiac surgery practice. Gastroepiploic artery proved superior patency rates, compared to saphenous vein grafts. Right coronary artery territory is an ideal anastomotic site for gastroepiploic artery grafting. The inferior epigastric artery may be used in addition to other arterial grafts as free graft or as y- or t-graft in the setting of multivessel coronary atherosclerotic lesions.&#x0D; Conclusion. Complete arterial revascularization provides symptomatic relief from coronary artery disease provides superior patency rates and lowers the incidence of major adverse cardiac events.

Left anterior descending artery revascularization with the right internal thoracic artery T-graft: the 'reverse composite' configuration.

The use of bilateral internal thoracic artery graft for myocardial revascularization has improved the long-term survival and decreased the rate of repeat interventions in patients. A key technical factor for complete arterial revascularization is sufficient length of the internal thoracic artery (ITA) graft. The purpose of this study was to compare early and long-term outcomes of 'standard composite' grafting and 'reverse composite' grafting. In the former, the left ITA (LITA) is connected to the left anterior descending artery, and the right ITA is connected end-to-side to the LITA for revascularization of the left circumflex artery. In 'reverse composite' grafting, the LITA is connected to the left circumflex artery, and the right ITA is connected end-to-side to the LITA, for revascularization of the left anterior descending artery. We compared the outcomes of 1365 patients who underwent coronary artery bypass grafting in Tel-Aviv Sourasky Medical Centre, using bilateral ITA as standard composite versus 'reverse composite' grafts, between January 1996 and December 2011. A propensity score matching analysis compared 132 pairs of patients who underwent bilateral ITA by the 2 modes. Twelve hundred and thirty patients underwent standard 'composite' grafts and 135 underwent 'reverse composite' grafts. Early mortality and early adverse effects did not differ significantly between the groups. After matching, the difference in late mortality between the groups was not statistically significant. This study suggests that revascularization of the left anterior descending with the right ITA, arising from an in situ LITA, is safe and provides early outcomes and long-term survival that are not significantly different from those of the standard composite grafting technique. However, there was evidence of better survival in the standard composite group.

ІННОВАЦІЙНИЙ ПІДХІД – МІНІІНВАЗИВНЕ БАГАТОСУДИННЕ КОРОНАРНЕ ШУНТУВАННЯ В УМОВАХ ПЕРЕДНЬОЇ ТОРАКОТОМІЇ

Personal experience with minimally invasive multivessel coronary grafting through left anterior thoracotomy is described. Currently, we use this technique routinely, regardless of the number of grafts, quality, and location of coronary targets, left ventricular ejection fraction, age, gender, body mass index. Our aim was to develop minimally invasive coronary artery bypass grafting technique, which would be equally effective and safe as compared to the conventional coronary grafting technique; would be reproducible and be applied for every patient with isolated coronary artery disease. 220 patients were operated and then analyzed. In all patients, complete revascularization was performed. Mean number of grafts was 3.37± 0.68 per patient (range 2-5). Left internal mammary artery was used in 206 patients, right internal mammary artery - in 4 patients, radial artery - in 37 patients, vein grafts - in 193 patients. Complete arterial revascularization was performed in 29 patients. We had no mortality. Mean aortic cross-clamp time was 70.7 ± 18.7 min (range 31 - 146 min). Mean cardiopulmonary bypass time was 137.5 ± 31.9 min (range 71 - 339 min). Postoperatively, total drainage in the first 12 hours was 376.7 ± 205.4 ml, ventilation time was 2.6 ± 1.4 hours, ICU stay was 2.3 ± 1.2 days. Conclusion. Minimally invasive coronary bypass grafting is an effective and safe surgical method. Complete revascularization could be performed regardless of the number of grafts, left ventricle ejection fraction, quality and size of coronary vessels, or age of the patient.

RF90 USE OF IMPELLA IN OFF PUMP MYOCARDIAL REVASCULARIZATION WITH EF BELOW 30 %.

Background and Aim: Patients undergoing coronary surgery are changed in the last years becoming a challenge for the cardiac surgeon not only for the quality of the coronary artery involved in the disease but mainly for the quality of patients in terms of low ejection fraction, elderly, COPD, kidney failure, Diabetes. Beating heart myocardial revascularization is a well established surgical technique but in case of very low EF (below 30%) there is a particular high surgical risk of conversion to on-pump surgery. The recently developed of Impella device (Abiomed, Danvers, MA) represent a compromise between circulatory support and limited invasiveness. Methods: Six patients, male, admitted for acute coronary syndrome with three vessels CAD with low ejection fraction were operated in our department. Impella Recover LP 5.0 device was inserted via surgical exposure of the right femoral artery in one case and an Impella recover LP 4,5 via percutaneous insertion of the femoral artery in five cases. Results: The myocardial revascularization was performed using a complete arterial revascularization. The device was left in for 48 Hours after the operation. All patients were discharged home after 9-10 days after admission and a follow up echocardiography performed six month up to two year after the operation showed an increase of the ejection fraction up to 40-45%. Conclusions: Use of the Impella Recover device for patients undergoing off pump CABG is feasible and safe, and appears a promising strategy to improve short- and long-term outcomes.

Miniinvasive multivessel coronary grafting through left anterior thoracotomy

The aim — to describe personal experience of miniinvasive multivessel coronary grafting through left anterior mini­thoracotomy with the application of artificial bloodcirculation and hyperkalemic blood cardioplegia; to assess the results of surgery in the first group patients.Materials and methods. The method was performed for 29 patients. All patients underwent complete myocardium revascularization with 2 — 5 grafts (3.37 ± 0.82 per patient). Left internal mammary artery was used in all patients, right internal mammary artery — in 4 patients, radial artery — in 5 patints, vein grafts — in 23 patients. Complete arterial revascularization was performed in 6 patients.Results and discussion. We had no fatal outcomes. Mean aortic crossclamp time was 75.8 ± 21 min (range 48 — 146 min). Mean cardiopulmonary bypass time was 145.5 ± 38.37 min (range 103 — 296 min). Total surgery duration was 180 — 495 min. (mean 287.4 ± 61.7). Postoperatively, total drainage in the first 12 hours was 456.55 ± 214.39 ml, the post surgery grafts were left for 48 hours. Ventilation time was 7.6 ± 15.6 hours, ICU stay was 2.58 ± 1.21 days.Conclusions. Miniinvasive coronary bypass grafitng is effective and safe surgical method for miocardium revascularization. Complete revascularization could be performed regardless the number of grafts, left ventricle ejection fraction, quality and size of coronary vessels, age of patient.

Total arterial complete revascularization versus combined complete revascularization in patients undergoing coronary artery bypass grafting: Early outcomes

BackgroundTotal arterial revascularization is a target to achieve in patients with coronary artery disease (CAD) especially in younger patients. This study sought to assess early outcomes after total arterial complete re-vascularization versus combined complete re-vascularization in patients undergoing coronary artery bypass surgery (CABG). MethodsIn a period of 12 months, a number of 104 successive patients subjected to on-pump isolated CABG (no other concomitant procedures) were included in our study. Those patients were divided into two main groups based on grafting strategy: Total arterial grafts “G1” (all arterial grafts no saphenous veins) and Left internal mammary artery (LIMA) in addition to saphenous vein grafts (SVG) “G2”. ResultsComplete arterial re-vascularization patients “G1”were younger, more often of male gender, better New York Heart Association (NYHA), less often operated upon urgently and more comorbid diseases without any significant difference. On the other hand, composite complete re-vascularization “G2” received more distal anastomosis than complete arterial re-vascularization patients “G1” without any significant difference. ConclusionsLooking for the early results it may be difficult to get a significant difference between total arterial revascularization and composite arterial and venous grafting.

Impact of Gender on Arterial Revascularization Strategies for Coronary Artery Bypass Grafting

There are significant gender differences in arterial revascularization approaches in coronary operations. This study addressed these differences to determine whether discrepancies are related to underlying risk profiles or systematic gender bias. Changes in gender-specific rates of revascularization approaches were determined in 19,557 patients undergoing isolated coronary artery bypass grafting (CABG). A propensity-balanced group was generated on a subset of 1,254 CABG patients based on 45 pretreatment covariates to assess rates in matched groups (627 patients per group). In the entire cohort, male gender was associated with increased bilateral internal thoracic artery (BITA) use (odds ratio, 1.667; 95% confidence interval [CI], 1.166 to 2.386; p= 0.005). Multiple-arterial grafting increased yearly in both genders, but the rate of increase in BITA use was greater in men (1.59%/year [95% CI, 1.56 to 1.63] vs 1.37%/year [95% CI, 1.30 to 1.45], p < 0.001) as was the use of 3 arteries (1.16%/year [95% CI, 1.13 to 1.20] vs 0.73%/year [95% CI, 0.67 to 0.80), p < 0.001) and the use of any 2 arteries (2.34%/year (95% CI, 2.32 to 2.35) vs 1.92%/year [95% CI, 1.90 to 1.95], p < 0.001). In the propensity-matched group, there was no difference in BITA use (male: 31.9%, female: 30.1%; p= 0.502), BITA use in low-risk patients (male: 46.4%, female: 38.0%; p= 0.126), or radial artery use (male: 44.5%, female: 44.1%; p= 0.994), but use of 3 arteries was greater in men (10.5% vs 7.3%, p= 0.048). Women receive less complete multiple arterial coronary revascularization than men. This is likely related to later presentation of coronary artery disease in women with higher comorbidity profiles; however, when matched, bias may still exist limiting the option of grafting with 3 arteries to women.

Complete arterial revascularization using bilateral internal mammary artery in T-graft technique for multivessel coronary artery disease in on- or off-pump approach: does gender lose its historical impact on clinical outcome?

Higher rates of mortality and morbidity have been reported in women undergoing coronary artery bypass grafting (CABG) compared with men. Different revascularization techniques (on-pump and off-pump) might influence this outcome. We retrospectively analysed 3445 consecutively recruited patients (all comers) undergoing complete arterial CABG (CACABG) at a single centre between January 2000 and December 2012. CACABG was performed in all patients using bilateral skeletonized internal mammary artery in T-graft technique, either on-pump (n = 2216) or off-pump (n = 1229). Early results (30-day) and long-term follow-up data were analysed with respect to gender-specific outcome. Women were older than men in both groups (P < 0.001), and men had a higher body mass index (on-pump: P < 0.001; off-pump: P = 0.02) compared with women. Men displayed a higher extent of coronary artery disease (P < 0.001) and an overall lower ejection fraction (P < 0.001) when undergoing on-pump CABG. No gender differences were observed for late survival (P = 0.74 vs P = 0.52) in on-pump and off-pump procedures, respectively. Late follow-up revealed a higher rate of FitzGibbon A graft patency in men undergoing the on-pump approach (P = 0.006). CACABG using bilateral internal mammary artery in T-graft technique showed excellent early and long-term results. No significant gender-specific differences were observed in both groups undergoing CACABG with respect to 30 days mortality and morbidity as well as late survival. However, late follow-up revealed a higher graft patency in men undergoing the on-pump approach, compared to women.

In-hospital and long-term outcomes of coronary artery bypass graft surgery in patients ≤ 45 years of age and older (from the KROK registry).

There is a paucity of data concerning the clinical characteristics, management, and outcomes of coronary artery bypass graft surgery (CABG) in patients ≤ 45 years old. We aimed to compare the clinical characteristics, and in-hospital and long-term outcomes of patients ≤ 45 years and > 45 years old, who underwent isolated CABG. We identified consecutive patients who had isolated CABG in the Department of Cardiac Surgery and Transplantology in the Silesian Centre for Heart Diseases in Zabrze between January 2006 and December 2011 and were enrolled in the Polish National Registry of Cardiac Surgery Procedures (KROK registry). A total of 8196 patients were identified and split into two groups, age ≤ 45 years old (young group; n = 130) and > 45 years old (old group; n = 8066). Patients ≤ 45 years old were less often females (18.5% vs. 27.6%, p < 0.027), more often smokers (84.6% vs. 66.9%, p < 0.0001), and had a higher incidence of previous myocardial infarction (MI) (40.8% vs. 29.6%, p = 0.008). Patients ≤ 45 years old more often received only one graft (27.7% vs. 15.0%, p < 0.0001), were operated on with minimally invasive direct coronary artery bypass (MIDCAB) technique (12.3% vs. 3.9%, p < 0.0001), and had complete arterial revascularisation (55.4% vs. 18.1%, p < 0.0001). There were no significant differences between the groups regarding in-hospital mortality (0.8% vs. 1.4%, p = 0.808). Long-term outcomes revealed that young patients, compared with the older patients, showed no significant differences in the number of MI (4.6% vs. 5.6%), unstable angina (8.5% vs. 9.9%), coronary angioplasty (12.3% vs. 15.1%), reCABG (0.8% vs. 0.1%), and strokes (2.3% vs. 4.3%) during the follow-up period; long-term mortality occurred less often in the young patients (4.6% vs. 15.0%, p = 0.002). We conclude that patients ≤ 45 years old requiring CABG differ from their older counterparts in clinical and surgical characteristics. We noted no significant differences in the in-hospital mortality; however, patients ≤ 45 years old had a lower mortality rate in the long-term follow-up.

Comparison of radial and bilateral internal thoracic artery grafting in patients with peripheral vascular disease†.

The composite T-graft with radial artery (RA) attached end-to-side to the left internal thoracic artery (ITA) provides arterial myocardial revascularization without the increased risk of deep sternal wound infection associated with harvesting 2 ITAs. However, many surgeons are reluctant to use RA in patients with peripheral vascular disease (PVD) due to concerns regarding the quality of the conduit in this subset of patients. The purpose of this study is to compare early- and long-term outcomes of arterial grafting with bilateral ITAs (BITA) to that of single ITA and RA in patients with PVD. Between 1999 and 2010, 619 consecutive patients with PVD (500 BITAs and 119 single ITA and RA) underwent myocardial revascularization in our institution. Occurrence of following risk factors as female sex, age 70+, diabetes, unstable angina, emergency operation, cerebrovascular disease and chronic obstructive pulmonary disease was higher in the RA-ITA group. The RA-ITA group also had a higher logistic EuroSCORE (22.1 vs 13.3). Operative mortality and occurrence of deep sternal wound infection of the two groups was similar (4.2% vs 5.0% and 2.5% vs 4.0% for the radial and bilateral ITA, respectively). Median follow-up was 9.75 years. Unadjusted Kaplan-Meier 10-year survival of the two groups was similar (44.1% vs 49.6%, P = 0.7). After propensity score matching (100 pairs), assignment to BITA was not associated with better adjusted survival (hazard ratio 0.593, 95% confidence interval 0.265-1.327, P = 0.20, Cox model). In patients with PVD, complete arterial revascularization with left ITA and RA can be justified with regards to survival.

Correction to: Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy

HomeStrokeVol. 48, No. 2Correction to: Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy Originally published1 Feb 2017https://doi.org/10.1161/STR.0000000000000121Stroke. 2017;48:e79This article corrects the followingIntracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical ThrombectomyIn the article by Hernández-Pérez et al, “Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy,” which published online ahead of print December 22, 2016, and appears in the February 2017 issue of the journal (Stroke. 2017;48:342–347. DOI: 10.1161/STROKEAHA.116.015166), a correction is needed.On page 345, left column, second line, the sentence read “Patients who achieved complete arterial revascularization had larger burden of ICAC…” has been changed to read “Patients who achieved complete arterial revascularization had lower burden of ICAC….”This correction has been made to the current online version of the article, which is available at http://stroke.ahajournals.org/content/48/2/342. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesIntracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical ThrombectomyMaría Hernández-Pérez, et al. Stroke. 2017;48:342-347 February 2017Vol 48, Issue 2 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/STR.0000000000000121PMID: 28115728 Originally publishedFebruary 1, 2017 PDF download Advertisement

Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy.

Intracranial carotid artery calcification (ICAC) is a surrogate marker of intracranial arteriosclerosis, which may impact the revascularization and clinical outcome of acute stroke patients who undergo mechanical thrombectomy. We included 194 patients admitted to our Stroke Unit between January 2009 and September 2015 who underwent mechanical thrombectomy for an anterior circulation occlusion. ICAC was quantified in both intracranial carotid arteries on the nonenhanced computed tomographic scan that was acquired before thrombectomy. Complete arterial revascularization was defined as a Thrombolysis in Cerebral Infarction ≥2b on the final angiographic examination. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 90 days. We assessed the independent effect of ICAC volume on complete arterial revascularization, functional outcome, and mortality using logistic regression models adjusted for relevant confounders. ICAC was present in 164 (84.5%) patients, with a median volume of 87.1 mm3 (25th-75th quartile: 18.9-254.6 mm3). We found that larger ICAC volumes were associated with incomplete arterial revascularization (adjusted odds ratio per unit increase in ln-transformed ICAC volume 0.73 [95% confidence interval, 0.57-0.93]) and with poorer functional outcome (adjusted odds ratio per unit increase in ln-transformed ICAC volume 1.31 [95% confidence interval, 1.04-1.66]). A larger amount of ICAC before mechanical thrombectomy in acute stroke patients is an indicator of worse postprocedural arterial revascularization and poorer functional outcome.