Intraaortic Balloon Pump After Treatment of Anomalous Origin of Left Coronary Artery (original) (raw)
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Left anterior descending coronary artery bypass grafting through minimal thoracotomy
The Annals of Thoracic Surgery, 1998
thoracotomy Left anterior descending coronary artery bypass grafting through minimal http://ats.ctsnetjournals.org/cgi/content/full/66/3/1008 on the World Wide Web at: The online version of this article, along with updated information and services, is located Print ISSN: 0003-4975; eISSN: 1552-6259. Southern Thoracic Surgical Association.
Can internal thoracic arteries be used for both coronary artery bypass and breast reconstruction?
Interactive cardiovascular and thoracic surgery, 2012
Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG). Anatomic analysis of 20 female patients undergoing CABG was performed examining internal thoracic artery length from its origin to the third, fourth, fifth intercostal spaces and the left anterior descending (LAD) artery target. The left internal thoracic artery was anastamosed to the LAD target at a mean length of 11.4 ± 1.4 cm. The mean lengths of the pedicled left internal thoracic artery from its origin to the third, fourth and fifth intercostal space were 8.5 ± 1.0, 10.9 ± 1.2 and 13.0 ± 1.4 cm, respectively. Therefore, the left internal thoracic artery length was adequate at the f...
Interactive cardiovascular and thoracic surgery, 2012
The internal mammary artery (IMA) is routinely used for grafting of the left anterior descending coronary artery (LAD), providing good flow to the anterior left ventricle (LV) wall. Impeded IMA-to-LAD flow may result in myocardial ischaemia and haemodynamic deterioration. From a study population, we describe two incidents where myocardial ischaemia was observed during off-pump coronary artery bypass surgery (CABG), with a confirmed reduction in the IMA-to-LAD flow in one patient. In patient no. 1, normal IMA flow was assessed by transit-time flow measurement after a complete IMA-to-LAD anastomosis. The anterior LV wall thickening was monitored continuously by epicardial ultrasonic transducers. Normal wall thickening was confirmed after IMA grafting. During a wide sternal opening for circumflex grafting the anterior wall motion displayed an ischaemic pattern, with reduced systolic and increased post-systolic wall thickening. IMA flow was reduced simultaneously. When easing the sterna...
Texas Heart Institute Journal from the Texas Heart Institute of St Luke S Episcopal Hospital Texas Children S Hospital, 2006
In situ right internal mammary artery is the graft of choice in reoperative off-pump coronary artery bypass grafting, as well as in primary on-pump coronary artery bypass grafting, unless the vessel has been used previously. However, there are not enough data about postoperative angiographic findings of the in situ right internal mammary artery in reoperative coronary artery bypass grafting with the off-pump technique.
Bilateral internal mammary artery grafts in reoperative and primary coronary bypass surgery
The Annals of Thoracic Surgery, 1991
Bilateral internal mammary artery grafting is recognized as a preferred method of myocardial revascularization. However, its efficacy in coronary bypass reoperation has not been clearly established. From January 1982 through June 1989, 88 patients underwent coronary bypass reoperation with bilateral internal mammary artery grafts. Results were compared with those for a subset of 88 patients receiving primary revascularization with bilateral internal mammary artery grafts who were computer matched for sex, age, left ventricular function, anginal classification, and left main coronary artery disease. In each group, 62.5% (55 patients) had unstable angina, 43.2% (38 patients) had reduced ejection fraction, and 21.6% (19 patients) in the reoperation group and 20.5% (18 patients) in the reference group had left main coronary artery disease. Hospital mortality for the reoperation group was 6.8% (6 patients) and for the reference group, 3.4% (3 patients). No significant difference was found in the incidence of reoperation for bleeding, eoperation for coronary artery disease has become a R standard procedure, accounting for 4% to 6% of all coronary bypass operations performed annually [ 11. The incidence of reoperation in patients followed up 10 and 15
Left Internal Mammary Artery Usage in Coronary Artery Bypass Grafting: A Measure of Quality Control
Annals of The Royal College of Surgeons of England, 2006
Approximately 4% of all patients undergoing first-time CABG do not need a graft to the LAD. 2. Of the rest, about 92% receive LIMA to LAD. 3. Six subgroups of patients in whom LIMA usage was significantly less were: (i) the elderly (> 70 years of age); (ii) females; (iii) diabetics; (iv) patients having emergency CABG; (v) poor left ventricular (LV) function (ejection fraction [EF] < 30%); and (vi) respiratory disease. LIMA usage was also reduced in patients undergoing combined CABG and valve procedures. 4. There were no significant differences in risk-adjusted, in-hospital mortality or morbidity whether LIMA was used or not.
Breast Cancer Research and Treatment, 2012
OBJECTIVE: To identify possible avenues of sparing the internal mammary artery (IMA) for coronary artery bypass grafting (CABG) in women undergoing autologous breast reconstruction with deep inferior epigastric artery perforator (DIEP) flaps. BACKGROUND: Optimal autologous reconstruction of the breast and coronary artery bypass grafting (CABG) are often mutually exclusive as they both require utilisation of the IMA as the preferred arterial conduit. Given the prevalence of both breast cancer and coronary artery disease, this is an important issue for women's health as women with DIEP flap reconstructions and women at increased risk of developing coronary artery disease are potentially restricted from receiving this reconstructive option should the other condition arise. METHODS: The largest clinical and cadaveric anatomical study (n=315) to date was performed, investigating four solutions to this predicament by correlating the precise requirements of breast reconstruction and CABG against the anatomical features of the in-situ IMAs. This information was supplemented by a thorough literature review. RESULTS: Minimum lengths of the left and right IMA needed for grafting to the left-anterior descending artery are 160•08mm and 177•80mm respectively. Based on anatomical findings, the suitable options for anastomosis to each intercostals space are offered. In addition, 87-91% of patients have IMA perforator vessels to which DIEP flaps can be anastomosed in the 1 st and 2 nd intercostal spaces. CONCLUSION: We outline five methods of preserving the IMA for future CABG: 1) lowering the level of DIEP flaps to the 4 th and 5 th intercostals spaces; 2) using the DIEP pedicle as an intermediary for CABG; 3) using IMA perforators to spare the IMA proper; 4) using and end-to-side anastomosis between the DIEP pedicle and IMA; and 5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG. Common methods of breast reconstruction post-mastectomy Latissimus Dorsi flap 9 Robust blood supply [130, 131] 9 Good salvage option for re-operations [130, 131] 9 A readily available option for almost all patients [131] 8 Limited volume compared to DIEP and TRAM flaps [129-31] Superior inferior epigastric artery (SIEA) flap 9 Minimally impact on abdominal wall function as fascia is no disrupted [130, 131] 8 Limited volume [130, 131] 8 Tenuous blood supply [130] 8 Higher rates of flap loss (2.9%) and re-operation (17.4%) [136] 8 Not suitable for women with inadequate abdominal adiposity [132] Two-stage reconstruction (expander plus implant) 9 Requires less skin than single-stage reconstructions [129] 8 Multiple consultations required over several months [129, 130] 8 Tissue expanders require muscle coverage to prevent extrusion and to achieve adequate bulk [129, 130] 8 Additional procedure required to replace expander with implant [130] Non-autologous (Implant-based) 9 Technically easier procedure with shorter operating time [129] 9 Lower initial costs than autologous methods ($15,497) [129, 133] 9 Less invasive and no donor site complications [129, 130] 8 May require revision surgery to achieve optimal aesthetic outcome [129,130] 8 The need for subsequent procedures substantially increases overall cost compared to autologous methods and the initial cost savings may be lost [129] 8 Complications include haematoma, infection, extrusion and capsular contracture, leak and rupture [129-32] 8 Appearance is less natural than autologous reconstructions. Breast asymmetry often requires modification procedure to be performed on the contralateral breast [129, 130] 8 Implants will eventually leak, thus one or more implant exchanges may be required in a lifetime [130] 8 Risk of complications is significantly increased by radiation [131] Single-stage reconstruction 9One stage procedure [129] 9Requires preservation of a sufficient amount of healthy skin at mastectomy site [129] 8 Size of reconstructed breast is limited [129] 8 Unsuitable for women with larger breasts [130] DIEP 9 Aesthetically superior contours [129] 9 Minimal donor site morbidity [129-32] 9 Longer lasting reconstruction at reasonable expense [23] 8 Technically difficult to perform [129, 115] 8 Increased risk of microvascular complications [129, 130] 8 Not suitable for women with inadequate abdominal adiposity [115] Autologous (Tissue-based) 9 Softer, more natural outcome [129, 130] 9 Greater volume available for reconstruction [129] 9 Concomitant abdominoplasty [130] 9 Minimal ongoing long-term costs (unlike implants) [133] 9 Less affected by radiation [131] 8 Technically more demanding [129] 8 Longer operating time and recovery [129] 8 Creates secondary defect at donor site [129,130] 8 Higher initial costs than implant based reconstructions $19,607 [133]
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