Mammary Graft Research Articles

Totally endoscopic coronary artery bypass grafting: experience in 1500 patients.

Totally endoscopic coronary artery bypass grafting (TECAB) is a minimally invasive approach to achieve surgical revascularization through a minimally invasive approach. Still, data regarding non-robotic TECAB are limited. This report presents the results of a TECAB technique using long-shafted instruments, defined as Endo-CABG, from a single-centre experience in 1500 consecutive patients. One thousand and five hundred patients underwent Endo-CABG between January 2016 and February 2023. Data were collected retrospectively, and patients were followed up for 1 year. The primary outcome of this study was major adverse cardiac and cerebrovascular events (MACCE)-free survival. Secondary efficacy outcomes were graft failure and mortality. Furthermore, we analysed factors influencing long-term freedom from MACCE and all-cause mortality. The mean age was 68 [61-75] years, of which 193 (12.87%) were octogenarians. Multivessel disease was present in 1409 (93.93%) patients, and the mean EuroSCORE II was 1.64 [1.09-2.92] %. All patients underwent full arterial revascularization with bilateral internal mammary grafting in 88.47%. Graft failure occurred in 1.80% of cases after 1 year (n = 27). Thirty-day mortality was 1.73% (n = 26), 1-year survival was 94.7% (95% CI: 93.5-95.9%; n = 26) and 1-year MACCE-free survival was 91.7% (95% CI: 90.2-93.2%). Age, left ventricular ejection fraction, arterial hypertension and urgency were significantly associated with 1-year MACCE-free survival. Endo-CABG appears to be a safe procedure, achieves surgical revascularization and provides good outcomes regarding graft failure and MACCE at 1 year, while age, left ventricular ejection fraction, arterial hypertension and urgency were associated with 1-year outcomes.

Hypothermic Ventricular Fibrillation in Redo Minimally Invasive Mitral Valve Surgery: A Promising Solution for a Surgical Challenge.

Background: Minimally invasive mitral valve surgery (MIMVS) is a treatment for severe mitral valve pathologies. In redo cases, especially after coronary artery bypass grafting (CABG) surgery with patent mammary bypass grafts, establishing aortic clamping followed by antegrade cardioplegia application might be challenging. Here, we present the outcome of hypothermic ventricular fibrillation as an alternative to conventional cardioprotection. Methods: Patients who underwent MIMVS either received hypothermic ventricular fibrillation (study group, n = 48) or antegrade cardioprotection (control group, n = 840) and were observed for 30 postoperative days. Data were retrospectively analyzed and collected from January 2011 until December 2022. Results: Patients in the study group had a higher preoperative prevalence of renal insufficiency (p = 0.001), extracardiac arteriopathy (p = 0.001), insulin-dependent diabetes mellitus (p = 0.001) and chronic lung disease (p = 0.036). Furthermore, they had a longer surgery time and a lower repair rate (p < 0.001). No difference, however, was seen in postoperative incidences of stroke (p = 0.26), myocardial infarction (p = 1) and mitral valve re-operation (p = 1) as well as 30-day mortality (p = 0.1) and postoperative mitral valve insufficiency or stenosis. Conclusions: The patients who underwent redo MIMVS with hypothermic ventricular fibrillation did not have worse outcomes or more serious adverse events compared to the patients who received routine conventional cardioprotection. Therefore, the use of hypothermic ventricular fibrillation appears to be a promising cardioprotective technique in this challenging patient population requiring redo MIMVS.

Incidence and healing times of postoperative sternal wound infections: a retrospective observational single-centre study

Objectives: Analyses of incidence and time required to heal sternal wound infections after heart surgery performed via a median sternotomy between 2020 and 2022. Results: Superficial wound infections (SWI) were five times more common (2.7%) than mediastinitis (0.5%) among 2693 patients. The median time between the operation and diagnosis of SWI was 26 (interquartile range [IQR] 15–33) days vs. 16 (IQR 9–25) days for mediastinitis (p = .12). Gram-negative bacteria caused 44% of the 85 infections. Sternal wound infection correlated to higher body mass index, female sex, smoking, diabetes mellitus, previous myocardial infarction, coronary artery bypass grafting, use of internal mammary graft, and re-entry for postoperative bleeding. Eight of 59 patients (13.6%) with sternal wound infections had bilateral mammary grafts, compared to 102 of 1191 patients (8.6%) without wound infections (p = .28). Negative pressure wound therapy was always used to treat mediastinitis and applied in 63% of patients with SWI. Two of 13 patients with mediastinitis (15%) and none of 72 patients with SWI died within 90 days after the operation. The median time until the wound healed was 1.9 (IQR 1.3–3.7) months after SWI vs. 1.7 (IQR 1.3–5.3) months after mediastinitis (p = .63). Six patients (7%) required longer than one year to treat the infection. Conclusions: Postoperative sternal wound infections usually appeared several weeks after surgery and were associated with factors as high body mass index, diabetes mellitus and coronary artery bypass. SWI were more common than mediastinitis and often required negative pressure wound therapy and similar treatment time as mediastinitis.

ПРИМЕНЕНИЕ МЕТОДА ЭКСТРАКОРПОРАЛЬНОЙ АУТОГЕМОМАГНИТОТЕРАПИИ С ЦЕЛЬЮ КОРРЕКЦИИ ГЕМОДИНАМИЧЕСКИХ НАРУШЕНИЙ В ИНТРАОПЕРАЦИОННОМ ПЕРИОДЕ ПРИ ПРОВЕДЕНИИ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ ИСКУCСТВЕННОГО КРОВООБРАЩЕНИЯ

Purpose of the study. To evaluate the effect of extracorporeal autohemomagnetic therapy on the parameters of central hemodynamics during surgical intervention for myocardial revascularization (aortocoronary and mammary coronary bypass surgery) under conditions of artificial circulation. Material and methods. The parameters of invasive hemodynamics of 100 patients who were treated in anesthesiology and intensive care units were studied. All patients were divided into 2 groups. Group 1 (50 people) received standard anesthesia (multicomponent balanced anesthesia) for coronary artery bypass grafting and mammary coronary artery bypass grafting under artificial circulation without the use of extracorporeal autohemomagnetic therapy. In group 2 (50 people), in addition to standard anesthesia autohemomagnetic therapy was used. Аfter catheterization of a. radialis dextra (sinistra) and v. jagularis interna dextra (sinistra), the invasive hemodynamics parameters were assessed using the Draeger Infinity Delta monitoring system (Germany): systolic blood pressure, diastolic blood pressure, mean arterial pressure, central venous pressure, heart rate. The parameters were studied at 2 stages of the surgical intervention: 10 minutes after induction of anesthesia, 10 minutes after administration of the calculated dose of protamine. Results. The use of autohemomagnetic therapy made it possible to increase the parameters of invasive central hemodynamics: systolic blood pressure, diastolic blood pressure, mean arterial pressure. The study of the parameters of heart rate and central venous pressure revealed no statistical differences. Conclusions. The use of extracorporeal autohemomagnetic therapy in the intraoperative period during myocardial revascularization can help correct hemodynamic disorders.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ПОКАЗАТЕЛЕЙ ДИНАМИКИ КОНЦЕНТРАЦИИ ТРОПОНИНА I ПОСЛЕ ВЫПОЛНЕНИЯ КОРОНАРНОГО ШУНТИРОВАНИЯ В УСЛОВИЯХ РАБОТАЮЩЕГО СЕРДЦА И ГИБРИДНОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА

Objective. To assess the prognostic significance of dynamic indicators of troponin I concentration after off-pump coronary artery bypass grafting (CABG) and hybrid myocardial revascularization (HMR) and identification of factors influencing the development of postoperative complications. Methods. The prospective single-center randomized comparative study included 180 patients with multifocal coronary artery disease. Group 1 (n = 98) consisted of patients who underwent off-pump CABG. Group 2 (n = 82) included patients who underwent hybrid myocardial revascularization. HMR consisted of two stages. The 1st stage was minimally invasive direct mammary coronary bypass grafting with access through a left minithoracotomy. The 2nd stage, 1–3 days after the open surgery, was percutaneous coronary intervention using drug-eluting stents. Results. The highest concentrations of Tn and AUC Tn after CABG are characteristic of patients with a peak content of the cardiac marker in the bloodstream 24 hours after surgery, which indicates a longer and more intense release of it into the bloodstream after surgery. Prognostically unfavorable for patients who have undergone CABG is an increase in the concentration of Tn by 12 hours after surgery (Tn 12in /Tn in ) by 68 times or more. Patients with Tn 12 /Tn in ≥ 68 have a sharply reduced event-free survival within 12 months after CABG (p = 0.001). Patients with a combination of Tn 12 /Tn in ≥ 68 and a late peak Tn concentration are at high risk of adverse clinical outcomes after CABG. A high level of Tn by 24 hours after breast cancer is associated with impaired carbohydrate metabolism: the presence of type 2 diabetes (r pb = 0.41), BMI (r pb = 0.33), preoperative concentrations of glucose (r pb = 0.35) and glycated hemoglobin (r pb = 0.41). Prognostic criteria for a Tn concentration of more than 0.2 ng/ml by 24 hours after breast cancer are the presence of CKD and the number of stented arteries in patients with elevated levels of glycated hemoglobin. Conclusion. With unidirectional changes in the concentration of highly-sensitive Tn I after CABG and HMR, a less pronounced release of the cardiomarker into the bloodstream in patients after HMR indicates less myocardial trauma during hybrid myocardial revascularization.

Coronary Involvement of Behçet's Disease: Saccular Coronary Artery Aneurysm.

Coronary artery aneurysms (CAAs) are rarely reported in large angiographic series. The majority are atherosclerotic in origin. Other causes are connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. We herein present the case of an symptomatic patient with a giant left anterior descending artery aneurysm. The CAA was successfully treated by surgical resection and a mammary artery bypass graft.

A clinical case of myocardial infarction after coronary artery bypass grafting using the internal mammary artery

Coronary artery bypass grafting (CABG) is the most preferred method of myocardial revascularization in multivessel coronary artery disease and severe progressive forms of the disease. The material of choice for CABG of the left anterior descending artery (LADA) is the internal mammary artery (IMA). However, even when using IMA as a conduit for CABG, one should be aware of a possibility of graft failure, which indicates a need for constant vigilance in this category of patients. Endovascular interventions on coronary arteries make it possible to efficiently and safely revascularize an occluded bypass graft, minimizing existing risks and improving both the quality of life of patients and their subsequent survival. The article considers a clinical case of the development of recurrent anterior myocardial infarction in the patient due to occlusion of the mammary graft to the LADA.

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

Reverse Controlled Antegrade and Retrograde Tracking in Left Internal Mammary Artery Bypass Grafts

Skeletonized Bilateral Internal Mammary Artery Coronary Grafting in Obese Diabetics: A Single Center Experience of Deep Sternal Wound Infections

Gaudio, Sean C MS4; Ogawa, Mitsugu MD, PhD; Tsukui, Hiroyuki MD, PhD; Culig, Michael MD, FACS Author Information

A Case of Successful Medical Treatment of Ventricular Tachycardia in a Patient With Ischemic Heart Disease and Heart Failure

The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.

Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention

BackgroundWhen patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft. ObjectivesThe aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI. MethodsThis study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality. ResultsOverall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non–ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality. ConclusionsPresenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.

Long-term survival of single versus bilateral internal mammary artery grafting in patients under 70.

OBJECTIVESAs definitive data from randomized controlled trials comparing the effect on long-term survival of using single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting are not yet available, observational studies allow for long-term follow-up in large and representative populations, which might complement the information potentially derived from randomized trials. To compare long-term survival in patients under 70 years of age undergoing SIMA or BIMA grafting.METHODSRetrospective analysis of 3384 consecutive patients under 70 years undergoing primary isolated coronary artery bypass grafting, performed from 2000 to 2015, in a Portuguese level III Hospital. We identified 2176 and 1208 patients from the study population who underwent SIMA and BIMA grafting, respectively. The primary end point was all-cause mortality at 10 years. We employed inverse probability weighting to restrict confounding by indication.RESULTSThe mean age of the study population was 59.4 (± 7.6) years, and 567 (16.8%) were females. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. Follow-up was 99.88% complete. The median follow-up time was 12.82 (interquartile range, 9.65, 16.74) years: the primary end point of all-cause mortality at 10 years occurred in 463 patients (21.3%) and 166 (13.7%) in the SIMA and BIMA grafting groups, respectively (hazard ratio, 0.78; 95% confidence interval, 0.66–0.92; P = 0.004).CONCLUSIONSBilateral internal mammary grafting is associated with lower long-term mortality than single internal mammary grafting. Moreover, this survival benefit comes at no increased perioperative morbidity or mortality cost.

СЛОЖНОСТИ ДИАГНОСТИКИ РЕДКИХ АНОМАЛИЙ КОРОНАРНЫХ АРТЕРИЙ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ АТРЕЗИИ УСТЬЯ ЛЕВОЙ КОРОНАРНОЙ АРТЕРИИ

One of the rarest isolated congenital anomalies of the coronary arteries (CA) is left main coronary artery ostial atresia (LMCAOA). Clinical manifestations of this pathology vary from asymptomatic to severe coronarogenic myocardial injury and even sudden death, depending on the state of collateral blood flow, which provides retrograde filling of the left CA from the right CA. Acute coronary insufficiency in children often manifests in syncopal conditions. If a routine cardiological examination does not reveal any pathology, the child may mistakenly become a patient with the neurological department. In this regard, the clinical observation given in the article is instructive: when the stress test made it possible to suspect, then the CT angiography confirmed the left main coronary artery ostial atresia in a 6 years old male patient. Mammary coronary artery bypass grafting, further supplemented by stenting of the resulting narrowing of the anastomosis, has allowed to achieve a good clinical effect with a favorable 2-year follow-up.

Use of papaverine in harvesting internal mammary graft in coronary artery bypass grafting: An update

AbstractThe left internal mammary artery (LIMA) graft is the main arterial graft that is used in coronary artery bypass grafting (CABG). The spasm of LIMA is a complication that frequently occurs while harvesting the LIMA and may lead to morbidity and mortality in patients after CABG. Clinically, papaverine is the most frequently used vasodilator. In this review, we evaluated the administration of papaverine in IMA grafts during CABG. It was shown that administration of papaverine into the LIMA improves the blood flow and abolishes vasospasm of the LIMA. Moreover, the intraluminal and perivascular administrations of papaverine are more effective than topical administration. Higher concentrations of papaverine should be used with caution because it may lead to endothelial damage.

C-2 | Comparing the Peri-procedural and Long-term Outcome between Minimally Invasive Hybrid Coronary Revascularization versus Percutaneous Coronary Intervention of Multivessel Coronary Artery Disease: A Meta Analysis

Hybrid Coronary Revascularization (HCR) involves harvesting Left Internal Mammary Artery (LIMA) and grafting it to Left Anterior Descending artery (LAD) with minimally invasive bypass surgery as well as percutaneous coronary intervention (PCI) of non- LAD arteries. The study aims to assess if there are any benefits of HCR when compared to PCI for both LAD and non-LAD lesions.

String sign recovery of the left internal mammary artery bypass graft.

String sign recovery of the left internal mammary artery bypass graft.

Very large aortic pseudoaneurysm repair using a septal occluder

A 63-year-old man, with previous coronary artery bypass surgery presented with infectious aortitis and a large ascending aorta pseudoaneurysm, causing compression of the left internal mammary graft. Percutaneous intervention with stenting of the graft followed by closure of the pseudoaneurysm using an atrial septal defect occluder was successfully carried out.

Tenascin‐C immobilizes infiltrating T lymphocytes through CXCL12 promoting breast cancer progression

Immune checkpoint therapy, where CD8 tumor infiltrating T lymphocytes (TIL) are reactivated, is a promising anti‐cancer treatment approach, yet with low response rates. The extracellular matrix, in particular tenascin‐C, may generate barriers for TIL. To investigate this possibility, we used a MMTV‐NeuNT and syngeneic mammary gland grafting model derived thereof with engineered tenascin‐C levels and observed accumulation of CD8 TIL in tenascin‐C‐rich stroma. Inhibition studies revealed that tenascin‐C induced CXCL12 through TLR4. By binding CXCL12, tenascin‐C retained CD8 TIL in the stroma. Blockade of CXCR4, the receptor of CXCL12, enhanced macrophage and CD8 TIL infiltration and reduced tumor growth and subsequent metastasis. Retention of CD8 TIL by tenascin‐C/CXCL12 was also observed in human breast cancer by tissue staining. Moreover, whereas high CD8 TIL numbers correlated with longer metastasis‐free survival, this was not the case when also tenascin‐C and CXCL12 levels were high. Altogether, these results may be useful for improving tumor immunity as diagnostic tool and to formulate a future “TIL‐matrix‐release‐and‐reactivate” strategy.

The extracellular-regulated protein kinase 5 (ERK5) enhances metastatic burden in triple-negative breast cancer through focal adhesion protein kinase (FAK)-mediated regulation of cell adhesion

There is overwhelming clinical evidence that the extracellular-regulated protein kinase 5 (ERK5) is significantly dysregulated in human breast cancer. However, there is no definite understanding of the requirement of ERK5 in tumor growth and metastasis due to very limited characterization of the pathway in disease models. In this study, we report that a high level of ERK5 is a predictive marker of metastatic breast cancer. Mechanistically, our in vitro data revealed that ERK5 was critical for maintaining the invasive capability of triple-negative breast cancer (TNBC) cells through focal adhesion protein kinase (FAK) activation. Specifically, we found that phosphorylation of FAK at Tyr397 was controlled by a kinase-independent function of ERK5. Accordingly, silencing ERK5 in mammary tumor grafts impaired FAK phosphorylation at Tyr397 and suppressed TNBC cell metastasis to the lung without preventing tumor growth. Collectively, these results establish a functional relationship between ERK5 and FAK signaling in promoting malignancy. Thus, targeting the oncogenic ERK5-FAK axis represents a promising therapeutic strategy for breast cancer exhibiting aggressive clinical behavior.

Hybrid coronary revascularization vs. percutaneous coronary interventions for multivessel coronary artery disease.

OBJECTIVEHybrid coronary revascularization (HCR) combines a minimally invasive surgical approach to the left anterior descending (LAD) artery with percutaneous coronary intervention (PCI) for non-LAD diseased coronary arteries. It is associated with shorter hospital lengths of stay and recovery times than conventional coronary artery bypass surgery, but there is little information comparing it to isolated PCI for multivessel disease. Our objective is to compare long-term outcomes of HCR and PCI for patients with multivessel disease.METHODSThis cohort study used data from New York’s cardiac surgery and PCI registries in 2010−2016 to examine mortality and repeat revascularization rates for patients with multivessel coronary artery disease who underwent HCR and PCI. Cox proportional hazards methods were used to reduce selection bias. Patients were followed for a median of four years.RESULTSThere was a total of 335 HCR patients (1.2%) and 25,557 PCI patients (98.8%) after exclusions. There was no difference in 6-year risk adjusted survival between HCR and PCI patients (83.17% vs. 81.65%, adjusted hazard ratio (aHR) = 0.90 (95% CI: 0.67−1.20). However, HCR patients were more likely to be free from repeat revascularization in the LAD artery (91.13% vs. 83.59%, aHR = 0.51 (95% CI: 0.34−0.77)). CONCLUSIONSFor patients with multi-vessel coronary artery disease, HCR is rarely performed. There are no differences in mortality rates after four years, but HCR is associated with lower repeat revascularization rates in the LAD artery, presumably due to better longevity in left arterial mammary grafts.