Single-vessel Coronary Artery Research Articles

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

In 1997, the first ambulatory off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis was performed via xiphoid approach, an intervention known today as the MINI-OPCAB operation. This operation has been performed in more than 150 patients around the world for the management of single and multiple vessel coronary artery disease, and 70 of those cases underwent the procedure in our Foundation from 1997 to 2021, showing no operative mortality or reintervention rates, low conversion rates, early hospital discharge, and 100% graft patency at the follow-ups. The minimally invasive direct coronary artery bypass (MIDCAB) procedure was introduced in 1994 by Benetti from Argentina, and was developed based on our previous experience performing off-pump coronary surgery by manipulating the ascending aorta through a left-sided small thoracotomy. Although it represents one of the most common minimally invasive procedures done worldwide, the original technique is not easy to reproduce, and in most cases the pleura is opened, which increases patients pain, morbidity, hospital length of stay, and hinders the realization of immediate hybrid revascularization after the procedure. The latest minimally invasive approaches for CABG include robotic-assisted procedures, in which the IMAs are harvested using robotic technology or the whole procedure is done using robotic technology. This approach has shown adequate short-term clinical results, however, there are no studies available reporting the procedure’s long-term results. Conclusion: The MINI-OPCAB operation is a friendly approach to perform Minimally Invasive Coronary Bypass Surgery in old, high-risk, multivessel coronary artery disease patients, and it represents a good intervention alternative for the majority of cardiac surgeons and cardiac specialized centers. We also consider this approach as ideal for patients who further require Hybrid Revascularization; however, more experience is needed to validate this initials results.

Factors associated with the presence of chronic mitral regurgitation in patients with stable coronary artery disease

Aim.To assess the incidence of moderate systolic dysfunction in patients with stable coronary artery disease and determine the factors associated with it.Methods.200 patients with coronary artery disease admitted to the Cardiology Department of the Research Institute for coronary artery bypass grafting were included in the study. Patients were assigned to two groups depending on the presence or absence of right ventricular systolic dysfunction (RVSD). Patients with RVSD (n = 30, 64 [59; 68] years), were assigned in Group 1, whereas patients without it (n = 170, 64 [60; 68] years) were assigned to Group 2.Results.Univariate logistic regression reported the following factors to be associated with RVSD: prior myocardial infarction (p = 0.098), chronic heart failure (p = 0.020), long smoking history (p = 0.003), increased left ventricular end-systolic and enddiastolic volumes (p = 0.005 and p = 0.004), decreased tricuspid annular plane systolic excursion (p <0.001), decreased early mitral flow propagation velocity (p = 0.027) and left ventricular ejection fraction (p = 0.002), significant circumflex artery stenosis (p = 0.075), right coronary artery occlusion (p = 0.073), singlevessel and three-vessel coronary artery disease (p = 0.055 and p = 0.014). Three multivariate models were generated. A decrease in the left ventricular ejection fraction (p = 0.009), three-vessel coronary artery disease (p = 0.055), and early mitral flow propagation velocity (p = 0.072) were considered as independent predictors of RVSD.Conclusion.Moderate RVSD was found in 15% of patients with stable coronary artery disease and preserved left ventricular function. A decrease in the left ventricular ejection fraction, but not damage to individual coronary arteries, the number of affected coronary arteries, the presence and localization of myocardial infarction were among the factors independently associated with right ventricular systolic function.

P830Differences in the usefulness of aggressive lipid-lowering therapy among single-vessel and multi-vessel coronary artery disease patients: HIJ-PROPER sub-study

Abstract Background Acute coronary syndrome (ACS) patients with multi-vessel disease (MVD) are at high risk of recurrent cardiovascular events. Previous study, examining stable atherosclerotic cardiac disease, reported that aggressive lipid-lowering therapy was more beneficial in MVD patients than in single-vessel disease (SVD) patients. However, no report has investigated the effects of aggressive lipid-lowering treatment according to the number of diseased coronary arteries in ACS patients. Purpose The purpose of the present study was to elucidate the efficacy of aggressive lipid-lowering therapy in ACS patients with MVD and SVD in modern early invasive strategy era. Methods The study population was derived from the HIJ-PROPER study, in which, ACS patients with dyslipidemia were randomized to pitavastatin + ezetimibe therapy (targeting LDL-C less than 70mg/dl) or pitavastatin-monotherapy (targeting LDL-C less than 90mg/dl). In the present study, the treatment efficacy was compared between patients with MVD and SVD. The primary end point was a composite of major advanced cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia driven revascularization. Results We identified 1702 eligible patients (mean age, 65.6 years; male, 75.6%); 869 patients (51.1%) had MVD and 833 (48.9%) patients had SVD. The rate of acute revascularization was 96.2%. The incidence of MACEs was significantly higher in MVD group compared to SVD group (43.7% vs 25.9%, hazard ratio 1.95, 95% confidence interval 1.65–2.31, p<0.001). In MVD group, there was no significant difference in MACEs between pitavastatin + ezetimibe therapy and pitavastatin-monotherapy group. (43.5% vs. 43.9%, 1.0, 0.82–1.23; p=0.95). However, in SVD group, pitavastatin + ezetimibe therapy showed significantly fewer MACEs than pitavastatin-monotherapy (34.6% vs. 47.4%, 0.72, 0.55–0.94, p=0.02). (Figure) Conclusion This study showed that ACS patients with SVD enjoyed significantly greater benefits from pitavastatin + ezetimibe therapy compared with pitavastatin monotherapy, whereas the patients with MVD did not. High rate of revascularization in acute phase of ACS might affect the efficacy of aggressive lipid-lowering therapy and our results in the present study suggest different treatment approach would be necessary in ACS patients with MVD in modern early invasive strategy era.

Skeletonization of Left Internal Mammary Artery in Coronary Artery Bypass Grafting.

To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery (LIMA) in patients undergoing coronary artery bypass grafting (CABG) surgery. Randomized control trial. Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC-NIHD), Rawalpindi, Pakistan from February to August, 2013. Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMAharvesting. Free flow was checked just before anastamosis of each LIMAto the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. Aspecialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18. The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group (p=0.04). Skeletonized IMAhad superior flow to pedicled IMAin addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization.

Characteristic markers of inflammation and lipid profile in patients with single-vessel and multivessel coronary artery disease

Characteristic markers of inflammation and lipid profile in patients with single-vessel and multivessel coronary artery disease

Perfusión y función ventricular en SPECT cardiaco y coronariografía del mismo día según localización en enfermedad de un vaso

Single-photon emission computed tomography (SPECT) can be used as a non-invasive tool for the assessment of coronary perfusion. To assess ventricular perfusion and function by SPECT in patients with single vessel coronary artery disease. Among patients with indications for a coronary artery angiography, those with significant lesions in one vessel, were selected for the study. Within 24 hours, cardiac SPECT examinations on basal conditions and after high doses of dipyridamole, were performed. SPECT data from 38 patients with a low probability of coronary artery disease was used for comparisons. Ten patients aged 61 ± 8 years (seven men) were studied. Visual analysis of SPECT revealed signs suggestive of ischemia in eight patients. The remaining two patients did not have perfusion disturbances. SPECT detected eight of ten abnormal vessels reported in the coronary artery angiography. There were two false negative results Summed stress, summed rest and summed difference scores were 9.78 ± 6.51, 3.22 ± 5.07 and 6.33 ± 4.97, respectively. The ejection fractions under stress and at rest were 53 ± 11.7% and 61 ± 15.7% respectively (p < 0.01). The figures for the control group were 69.1 ± 13.5% and 75.2 ± 12.04% respectively (significantly different from patients). Two patients had a summed motion score above 14.9. Likewise, two patients had a summed thickening score above 10.9. SPECT detected 80% of coronary lesions found during coronary artery angiography. Visual analysis of perfusion is highly reliable for diagnosis. Quantitative parameters must be considered only as reference parameters.

Improved detection of coronary artery disease by estimated myocardial thallium uptake.

Myocardial thallium uptake has been assessed at the time of thallium scanning in a group of 50 male patients undergoing coronary arteriography and 10 young healthy volunteers. The net thallium dose injected was obtained by counting the dose prior to injection using the gamma camera and counting the syringe and IV cannula after injection. Significantly higher levels of myocardial thallium uptake were obtained in both the volunteers and patients with normal coronary anatomy (1.36% +/- 0.32%, n = 10 and 0.93% +/- 0.26%, n = 9, respectively) compared to patients with single, double or triple vessel coronary artery disease (0.63% +/- 0.19%, n = 11; 0.70% +/- 0.20%, n = 15; 0.67 +/- 0.18, n = 15, respectively). Exercise tests were positive in 46% of patients with coronary artery disease with an overall predictive accuracy of 56%. Thallium scans were positive in 68% of patients at a specificity of 89%. If the range of myocardial thallium uptake from the patients with normal coronary arteries is used to define a lower limit of normal, then the sensitivity of the thallium scan with thallium uptake is 90% with a predictive accuracy of 90% in the detection of significant coronary artery disease in this group of patients. Thus, estimation of total % thallium uptake is a simple index which yields useful diagnostic clinical information.

Risk factor and sex differences in single versus multiple vessel coronary artery disease.

We analyzed 305 patients with either single or multiple vessel disease, as demonstrated by coronary arteriography, to determine risk factor and sex differences. Women accounted for more than one fourth of the patients with single vessel disease (group A), but for only one seventh of the individuals with multiple vessel disease (group B). Group A patients were younger and had fewer risk factors, and fewer abnormalities on chest roentgenogram, ECG, and stress test than those in group B. The better reported prognosis for patients with single (versus multiple) vessel coronary artery disease may be due to (1) slightly younger age, (2) greater representation by women, (3) fewer functional abnormalities as assessed by noninvasive tests, and (4) a lower incidence of cardiac risk factors. The presence of hypertension and diabetes seemed most likely to defeat the biologic advantage enjoyed by women over men in resistance to the development of atherosclerotic heart disease.

Nocturnal Angina Pectoris With Disease of a Single Coronary Artery

A premenopausal woman with nocturnal angina pectoris and severe, focal, single-vessel coronary artery (left anterior descending) disease was successfully treated with coronary artery bypass surgery. A possible cause of the angina decubitus in this case was redistribution of fluid, with consequent left ventricular failure.