Left internal mammary artery bypass dysfunction after revascularization of moderately narrowed coronary lesions. Colour-duplex ultrasound versus angiography study (original) (raw)
Related papers
Journal of Cardiac Surgery, 2007
Redo coronary artery bypass grafting (CABG) compromises a growing proportion of CABG in the current era of revascularization. Intimal hyperplasia at the site of anastomosis between left internal mammary artery (LIMA) and left anterior descending artery (LAD) is not infrequently reported causing severe ischemic symptoms in some patients. An additional grafting to distal LAD territory is a proper decision for the surgical strategy in most of the cases. Radial artery or venous grafts have been used for this purpose. Shortage of arterial grafts is the major concern in redo coronary surgery. Whether the previously anastomosed LIMA can be used is a major question in decision-making process. In this case report, we presented a complicated patient in whom LIMA was not reused although visual or angiographical examination was normal.
Intraoperative Angiography in Minimally Invasive Direct Coronary Artery Bypass Grafting
The Annals of Thoracic Surgery, 1997
Intraoperative angiography in minimally invasive direct coronary artery bypass grafting without cardiopulmonary bypass and in hybrid procedures is reported. Twelve procedures were performed in a specially designed surgical-radiologic suite with a cross-disciplinary organization. In 2 patients the anastomosis was successfully revised on the basis of angiographic findings. In 4 of the 12 patients anastomosis of the left internal mammary artery to the left anterior descending coronary artery performed as a minimally invasive direct coronary artery bypass grafting procedure was combined with percutaneous transluminal coronary angioplasty of lesions in other coronary vessels in the same session. Intraoperative angiography allows a reliable diagnosis of an anastomosis or graft failure and prompt and reliable correction, and it allows the combination of minimally invasive direct coronary artery bypass grafting and angioplasty in one session.
The American Journal of Cardiology, 1996
Revascularization Investigation (BARI) randomized 1,829 patients to percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). Clinical site angiogmphers categorized lesions of 2 50% diameter stenosis (n = 4,977) as clinically significant (86.4%) or nonsignificant (13.6%), and as favorable or nonfavorable for PTCA or CABG. More lesions were considered favorable for revascularization by CABG than by PTCA (9 1.5% vs 78.4%; p <O.OOl), particularly in the subgroup of 99% to 100% lesions (77.6% for CABG vs 2 1.9% for PTCA; p <O.OOl ). lesion features, characterized by the BARI core laboratory, were correlated with clinical site angiographers' assessment of clinical importance and suitability for PTCA or CABG. By multivariate analysis, positive predictors of clinical importance for 50% to 95% stenoses were greater stenosis severity, more jeopardized myocardium, larger reference diameter, and proximal vessel location. For 99% to 100% occlusions, pre-dictors were shorter duration of occlusion and more jeopardized myocardium. PTCA suitability for 50% to 95% stenoses was inversely related to lesion length, ostial location, location on a bend, difficult access, and age, and was directly associated with greater Thrombolysis in Myocardial Infarction (TIM) trial flow Irate and more jeopardized myocardium.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2007
Objective The aim of this study was to evaluate and compare the postoperative graft patency by multislice computed tomography (MSCT) and invasive coronary angiography (ICA) in patients with multivessel coronary artery bypass grafting at 1 year of surgery. Methods Patients (n = 114) who underwent isolated coronary artery bypass grafting at least 1 year (1.4 ± 0.4 years) previously were subjected to both 16-slice CT angiography with cardiac gating and ICA, and their results were evaluated and compared. All patients were receiving β-blockers; mean heart rate was 64 ± 6 beats/min. Results The mean age of the patients was 59.7 ± 8.5 years. There was a total of 338 grafts (113 internal mammary artery grafts, 8 radial artery grafts, and 217 saphenous venous grafts). On MSCT angiography, all the left internal mammary arteries were visualized with 3D reconstruction. All internal mammary arteries were found to be patent. Twenty-one grafts were occluded or stenosed (21/338, 6.25%). One occlude...
Patency When Grafted to Coronary Stenosis More Than 50% in LIMA-RA-Y Grafts
Heart Lung and Circulation, 2020
Background Recent coronary surgery practice is to graft arterial conduits to more severely stenosed coronary targets than in the past. We aimed to investigate postoperative arterial graft patency with native coronary stenosis at the time of surgery, using the left internal mammary artery and radial artery (RA) as a composite Y graft (LIMA-RAY). In the study timeframe, it was routine clinical practice to graft coronary arteries with .50% stenosis. Methods Of 464 patients previously reported 1996-1999, 346 who underwent LIMA-RAY at the Royal Melbourne Hospital, 76 had postoperative angiograms at the same institution. Each anastomosis was considered separately. For arterial grafts a "string sign" was analysed as being occluded. Predictor of patency was performed with a generalised linear mixed model (GLMM). Results Seventy-six (76) patients had postoperative angiograms at 5.865.4 years (range 0.23-19.4; interquartile range 1.7-10.0) years postoperative; with age at operation 62.5610.7 years and 3.460.8 grafts per patient, 82% were male. Of 256 anastomoses, 230 were to coronary targets .50% stenosis. Overall patency was 84.0% (214/256). For coronary stenosis .50%, patency was 88% (201/230) and varied by coronary territory left anterior descending (LAD) 94% (87/93), circumflex 90% (71/79) and right coronary artery (RCA) 74% (43/58). Interaction for coronary territory was significant (p=0.022). Higher preoperative coronary stenosis predicted higher patency; with odds ratio for improved patency of 1.83 (95% CI 1.51, 2.22), p,0.001 for each 10% increase in stenosis. Conclusions Late patency of composite arterial grafts is acceptable when grafted to coronary arteries of greater than 50% stenosis.
Cardiovascular Surgery, 2003
Patients with significant risk factors are at increased risk of higher mortality and morbidity (9-16%) after CABG-procedures with cardiopulmonary bypass (CPB). When catheter interventions are not applicable and conventional CABG with CPB are considered to have an unacceptable perioperative risk, these patients (n = 35) were scheduled for minimally invasive coronary artery bypass grafting (MIDCAB). Patients and methods: The risks leading to exclusion of conventional CABG procedures were: extremely impaired LV-function (EF Ͻ 20%), severe pulmonary diseases, malignant carcinoma, compromised coagulation system, age Ͼ80 years with impaired physical constitution, redoprocedures after complicated initial operation, symptomatic descending thoracic aortic aneurysm, ongoing long-term intensive care treatment with unclear prognosis. All patients received the LIMA as a single graft to the LAD. One year follow-up was performed using transthoracic Doppler echocardiography at rest and during exercise. Results: In 20 patients incomplete revascularization was accepted. There was no mortality, while signs for myocardial infarction were seen in two patients. Twenty-nine patients (82%) showed clear improvement of clinical symptoms, one patient needed further conventional CABG. Nine to thirteen months postoperatively (mean 10.8 ± 1.6 months), there were two deaths due to noncardiac reasons. Three of the survivors (n = 33) had symptoms of angina pectoris. Exercise tests revealed an improved stress tolerance (NYHA class improved from preop. III-IV to postop. I-II). The IMA graft flow increased significantly with exercise in all patients. Flow patterns in both flow velocity and volume changed to diastolic-dominant, and the ratio of diastolic to systolic time-velocity integral of Ͼ1.5 excluded a graft stenosis. Conclusions: In high-risk patients, with an increased likelihood of perioperative morbidity