Left Internal Mammary Artery Conduit Research Articles

On-pump total arterial revascularization in coronary artery disease patients with left ventricular dysfunction: a multi-center retrospective study

Objective: To evaluate the clinical outcomes of on-pump total arterial revascularization with bilateral radial artery (BRA) and left internal mammary artery (LIMA) as conduits in coronary artery bypass grafting (CABG) patients with left ventricular dysfunction (LVD). Methods: All the perioperative medical records and follow-up results of coronary artery disease patients with left ventricular ejection fraction (LVEF) ≤ 40% undergoing CABG from 24 heart centers of 15 provinces and autonomous regions in China between July 2015 and December 2019 were retrospectively analyzed. Results: A total of 87 consecutive patients (55 males and 32 females) underwent on-pump CABG with BRA and LIMA, with a mean age of (57.5±9.1) years old. There were 22 patients complicated with primary hypertension, 12 with diabetes mellitus, 8 with peripheral vascular disease, 7 with chronic obstructive lung disease, 12 with mild renal injury and 3 with partial aortic calcification. There were 43 cases with in-stent stenosis, and 21 had left main disease. The mean LVEF and left ventricular end-diastolic diameter (LVEDD) was (35.5±7.3)% and (65.5±2.6) mm, respectively. The mean graft number, aortic cross-clamp time and cardiopulmonary bypass duration was 3.2±0.9, (90.5±22.7) min and (113.4±19.2) min, respectively. There were 32 mitral and 9 aortic valve replacements, and 5 tricuspid annuloplasties. Prophylactic intra-aortic balloon pumps were implanted in 27 patients. There were 2 operative deaths from acute heart failure. After surgery, there were 15 cases of atrial fibrillation, 1 case of acute kidney injury, 1 case of acute myocardial infarction, and 1 cases of stroke. All the patients fulfilled the follow-up, with a mean time of (39.5±7.7) months. At 3 months after surgery, LVEDD was decreased and LVEF was improved significantly compared with pre-operative indicators [(53.0±1.5) mm vs (65.5±2.6) mm, t=9.51 P=0.02; (45.2±3.3)% vs (35.5±7.3)%, t=13.79, P=0.001]. No major cardiac events were reported during the follow-up. At (30.5±7.4) months after surgery, 62.4% of patients (53/85) underwent coronary CT angiography examination, and the results indicated that the graft patency was 98.8%, with only one case of RA occlusion occurred. Conclusion: In selected patients of LVD, on-pump total arterial revascularization with BRA and LIMA conduits was proved to be safe and effective.

Refractory Angina Secondary to Large Unligated Side Branch of Internal Mammary Artery

Coronary artery disease (CAD) has become a common diagnosis. Managing the symptoms of CAD continues to be an ongoing dilemma requiring optimal medication management or potential revascularization with either percutaneous coronary interventions or coronary artery bypass grafting (CABG). We present a case of debilitating refractory angina in a patient with severe CAD after optimal medical therapy and CABG secondary to coronary steal phenomenon via the left internal mammary artery conduit supplying a large unligated side branch to the internal chest wall. While current data are inconclusive on this phenomenon, our patient had complete resolution of angina following coil embolization of unligated side branch of the internal mammary artery.

On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

Objective:To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery.Methods:The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19.Results:In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424.Conclusions:The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit.

Internal mammary artery conduit re-use in coronary artery bypass grafting: Case series and review

Left internal mammary artery (LIMA) conduit is the gold standard graft for coronary artery bypass. Due to excellent patency rates with this graft it can safely be used in re-operative coronary bypass surgery. The safety of this technique is demonstrated with our report of re-used LIMA conduits in patients with extensive coronary artery disease (CAD). The success of this technique was evaluated by postoperative computerized tomographic angiography which demonstrated patent conduits and flow to the left anterior descending artery (LAD).

Relief of Angina Pectoris When Carrying Heavy Loads with the Left Hand in a Patient with Previous Coronary Artery Bypass Graft Operation Who Has Severe Exercise Angina: A Case Report

In patients with known coronary artery disease and/or a history of revascularization, angina pectoris or unstable coronary syndromes are usually attributed to the progression of atherosclerotic lesions rather than an unrecognized great vessel disease. However, for patients with a previous coronary artery bypass graft operation (CABG), during which a left internal mammary artery (LIMA) conduit has been used, great vessel disease, especially subclavian artery stenosis should also be suspected. We present a case of a patient with a LIMA conduit who has angina pectoris on exertion, but interestingly the pain is relieved when he carries heavy loads with his left hand, which can be due to increased blood flow to the LIMA conduit during heavy lifting because of increased peripheral resistance.

Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting

: Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG. : A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score. : A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB. : OPCAB can be safely and effectively applied to reoperative CABG in selected cases.

Part XIII: Role of large pectoralis branch artery in flow through a patent left internal mammary artery conduit

Catheterization and Cardiovascular DiagnosisVolume 34, Issue 3 p. 240-244 Interventional Physiology Part XIII: Role of large pectoralis branch artery in flow through a patent left internal mammary artery conduit Morton J. Kern MD, Corresponding Author Morton J. Kern MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriDirector, J.G. Mudd Cardiac Catheterization Laboratory, St. Louis University Hospital, 3635 Vista Avenue at Grand, St. Louis, MO 63110Search for more papers by this authorRichard G. Bach MD, Richard G. Bach MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorThomas J. Donohue MD, Thomas J. Donohue MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorEugene A. Caracciolo MD, Eugene A. Caracciolo MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorThomas Wolford MD, Thomas Wolford MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorFrank V. Aguirre MD, Frank V. Aguirre MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this author Morton J. Kern MD, Corresponding Author Morton J. Kern MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriDirector, J.G. Mudd Cardiac Catheterization Laboratory, St. Louis University Hospital, 3635 Vista Avenue at Grand, St. Louis, MO 63110Search for more papers by this authorRichard G. Bach MD, Richard G. Bach MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorThomas J. Donohue MD, Thomas J. Donohue MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorEugene A. Caracciolo MD, Eugene A. Caracciolo MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorThomas Wolford MD, Thomas Wolford MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this authorFrank V. Aguirre MD, Frank V. Aguirre MD Department of Internal Medicine, Division of Cardiology, St. Louis University, St. Louis, MissouriSearch for more papers by this author First published: March 1995 https://doi.org/10.1002/ccd.1810340115Citations: 22AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume34, Issue3March 1995Pages 240-244 SCAI Member Sign in RelatedInformation