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![In this anastomosis the suture line is initiated at the mid-point of the heel (A) and three bites taken toward the surgeon (B) and three bites taken away from the surgeon (C) and the suture line tightened (D). The far side of the anastomosis is made (E), then the toe (F) before completing the near side (G) (Reproduced from Edmunds LH. Cardiac surgery in the adult. New York: McGraw-Hill; 1997, with permission from the McGraw-Hill Companies) [23].](profile/Hendrick-Barner/publication/234012524/figure/fig2/AS:202934961872900@1425394873420/In-this-anastomosis-the-suture-line-is-initiated-at-the-mid-point-of-the-heel-A-and.png)
In this anastomosis the suture line is initiated at the mid-point of the heel (A) and three bites taken toward the surgeon (B) and three bites taken away from the surgeon (C) and the suture line tightened (D). The far side of the anastomosis is made (E), then the toe (F) before completing the near side (G) (Reproduced from Edmunds LH. Cardiac surgery in the adult. New York: McGraw-Hill; 1997, with permission from the McGraw-Hill Companies) [23].
Source publication
This second report in the series on coronary artery bypass presents the authors experience and personal views on the internal thoracic artery (ITA) which date to 1966. There has been a very gradual evolution in the acceptance of this conduit which was initially compared with the saphenous vein and viewed as an improbable alternative to it. As is co...
Context in source publication
Context 1
... shortest route from the thoracic inlet to the LAD is parallel to the phrenic nerve so it is logical to position the artery adjacent to it until the artery enters the pericardial space which is achieved by incising the pericardium trans- suture and continuing clockwise thorough the toe and back to the starting point (Fig. 2) [23]. Prior to completion gentle probing of 5 to 10 mm, with a coronary sized probe, in both directions will ascertain that there is no anastomotic ...Similar publications
Objectives:
To determine whether the use of the radial artery (RA) vs the saphenous vein (SV) as the second grafting conduit with the internal thoracic artery (ITA) confers a late-survival advantage in diabetes mellitus (DM).
Methods:
We reviewed our 1996-2007 DM coronary artery bypass grafting (CABG) experience. Study patients (N = 2281) includ...
Left internal thoracic artery (LITA) has increased importance and common use in coronary bypass grafting because of long-term better patency rate and improvement in both the duration and quality of survival of patients. LITA is a branch of the first part of the subclavian artery. We report a case in which the LITA originated from the second left in...
[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002,
III45005 i 41022]
Background:
Multiple arterial grafts, in addition to the left internal thoracic artery, improve long-term survival after coronary artery bypass grafting (CABG); yet, the use of this procedure remains low for both the right internal thoracic artery (RITA) and the radial artery (RA). To identify the optimal arterial conduit to deploy for revasculari...
The choice of conduits for surgical revascularization in patients with aortic coarctation can be puzzling, as the internal
thoracic arteries can be dilated, atherosclerotic and unsuitable for grafting. Reports in the literature are controversial:
in some cases, the internal thoracic artery was not suitable for revascularization, while in others, it...
Citations
... дръжливост в сравнение с всички други графтове [1,2]. Диаметърът на реципиентния съд, прогресията на атеросклеротичния процес, употребата на аспирин след байпас-хирургия, конкурентният кръвоток от нативния съд, стеснение в зоната на дистална анастомоза, дислипидемия са сред причините за стеноза на LIMA графт [3][4][5]. ...
... TG -1.7 mmol/L (0.4-1.7); CPK -345 U/L (0-175U/l); MB -45U/L(0-22U/L); Tn -0.12 ng/ml (0.00-0.04); ЕКГ (фиг. 1) -предсърдно мъждене с налична ST-елевация в отвеждания I, aVL, V1-V6 other grafts [1,2]. The diameter of the recipient vessel, the progression of the atherosclerotic process, the use of aspirin after bypass surgery, competitive blood flow from the native vessel, narrowing in the distal anastomosis zone, dyslipidemia are among the causes of LIMA graft stenosis [3][4][5]. ...
Left anterior descending artery (LAD) bypass via left internal mammary artery (LIMA) as an arterial graft in the cardiac surgical treatment of multivessel ischemic heart disease is the gold standard due to its long-term patency and durability compared to all other grafts. Acute LIMA thrombosis causing acute coronary syndrome is rare. Several cases of acute LIMA occlusion in the late postoperative period are described in the literature, as one of the patients died during the procedure and the others undergoing successful percutaneous coronary intervention (PCI). Here we report a case of probable thromboembolic event in the LIMA graft area 8 years after CABG causing an anterior acute anterior myocardial infarction with ST elevation and managed with aggressive pharmacotherapy.
... The Internal thoracic artery (ITA) plays a vital role in coronary artery bypass grafting (CABG). The left ITA is the gold standard conduit in grafting the left anterior descending coronary artery (LAD) [1]. During coronary artery bypass grafting (CABG), the internal thoracic artery may be harvested either as a pedicle together with the accompanying veins, lymphatics, sympathetic plexus, and internal thoracic fascia or skeletonized free of all surrounding tissues [2,3]. ...
Abstract
Background: Internal thoracic artery became the cornerstone graft in coronary artery bypass grafting. This study aimed to investigate sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized versus pedicled internal thoracic artery.
Methods: 100 patients who underwent isolated CABG were divided into two groups; skeletonized internal thoracic artery (ITA) (50 patients) and pedicled internal thoracic artery (50 patients). The postoperative assessment was performed three months after surgery. Physical and radiological examinations were performed after surgery to assess sternal healing.
Results: There was no significant difference in patients’ demographics between groups. Skeletonized group had more diabetic patients (65% vs 44%; p= 0.016). There was no significant difference between the two groups regarding the number of grafts (2.72 ± 0.89 vs. 2.68 ± 0.90; skeletonized vs pedicled group; p= 0.84). Harvesting time was longer in the skeletonized group (55.69 ± 8.80 vs. 44.28 ± 6.95 minutes; p=0.09). Superficial wound infection occurred more frequently in the pedicled group (24% vs. 8%; p=0.03).
Conclusion: Skeletonization of the internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG compared to the pedicled technique. However, skeletonization of internal thoracic artery conduits prolongs the operation time and requires more surgical skills.
... The Internal thoracic artery (ITA) plays a vital role in coronary artery bypass grafting (CABG). The left ITA is the gold standard conduit in grafting the left anterior descending coronary artery (LAD) [1]. During coronary artery bypass grafting (CABG), the internal thoracic artery may be harvested either as a pedicle together with the accompanying veins, lymphatics, sympathetic plexus, and internal thoracic fascia or skeletonized free of all surrounding tissues [2,3]. ...
Background: Internal thoracic artery became the cornerstone graft in coronary artery bypass grafting. This study aimed to investigate sternal healing and wound infection in patients undergoing coronary artery bypass graft (CABG) surgery using skeletonized versus pedicled internal thoracic artery. Methods: 100 patients who underwent isolated CABG were divided into two groups; skeletonized internal thoracic artery (ITA) (50 patients) and pedicled internal thoracic artery (50 patients). The postoperative assessment was performed three months after surgery. Physical and radiological examinations were performed after surgery to assess sternal healing. Results: There was no significant difference in patients’ demographics between groups. Skeletonized group had more diabetic patients (65% vs 44%; p= 0.016). There was no significant difference between the two groups regarding the number of grafts (2.72 ± 0.89 vs. 2.68 ± 0.90; skeletonized vs pedicled group; p= 0.84). Harvesting time was longer in the skeletonized group (55.69 ± 8.80 vs. 44.28 ± 6.95 minutes; p=0.09). Superficial wound infection occurred more frequently in the pedicled group (24% vs. 8%; p=0.03). Conclusion: Skeletonization of the internal thoracic artery conduits lowers the risk of superficial and deep sternal wound infection in patients undergoing CABG compared to the pedicled technique. However, skeletonization of internal thoracic artery conduits prolongs the operation time and requires more surgical skills.
... As a result of advancements in operative techniques and myocardial protection, operative mortality of HCO 829 CABG has reduced significantly (1% in planned cases) [4] and is no longer in question, but the longevity of the procedure is. As stated by Barner [5], 'Only continued patency of a graft or stent provides benefit.' Long-term venous graft patency is disappointing and has not changed for 44 years: Fitzgibbon et al. [6] reported in 1996 a series of 5065 grafts from 1969 to 1994 (25 years' span) with venous graft patency of 50% for at least 15 years, and Tatoulis et al. [7] reported in 2011 3238 venous grafts from 1986 to 2008 (22 years' span) with a patency of 50.7% at 15 years. ...
... Conversely, arterial grafts increase their diameter over time [35 && ] and, in particular, left IMAs have been known to revascularize the whole of the LCA circulation in cases of isolated/predominant left main stenosis (Fig. 1). IMAs are the arterial conduit least affected by competitive flow; generally there is no critical level of stenosis below which graft flow is compromised [5]. Sabik et al. [37] studied 2121 IMAs from 1972 to 1999, and found that, although IMA patency diminished as the degree of coronary stenosis decreased, at no particular degree of stenosis was there a sharp decline in patency. ...
... Possibly the different diastolic filling of the right (50%) and left coronary arteries (66%) could explain this: the RCA segment fails because two disparate pressure systems are grafted with one inflow. For the radial artery graft, Barner [5] was the first to identify the relation of native coronary stenosis and radial artery patency; he found that patency was worse in moderate stenosis ( 70%) compared with critical stenosis (!90%). Shah's review showed radial artery graft patency to be significantly reduced from 90 to 60% when grafts were placed to fewer than 70% stenotic arteries [39]. ...
Arterial grafting is superior to venous grafting in coronary artery bypass graft surgery with respect to graft patency and long-term patient outcome, but it may be difficult to achieve complete arterial revascularization.
Use of arterial grafts, especially bilateral internal mammary artery grafts, is not common, whereas there are clear indications that it may increase survival. Definitions of complete revascularization are varied and confusing, making study comparisons difficult. Technical challenges in complete revascularization with arterial grafts can be minimized by surgical techniques. Competitive flow in moderately stenosed coronary arteries grafted with arterial conduits may result in reduced patency. While internal mammary arteries may be used in arteries with at least 60% stenosis, radial artery and gastroepiploic grafts are best placed onto coronaries with severe stenosis. Moderate lesions in the left coronary circulation should be bypassed, but right coronary artery lesions can be left untouched as there is minimal progression over time. Complete revascularization may not be necessary or possible in every patient because of technical challenges.
Complete revascularization with arterial grafts presents both technical and physiological challenges. However, with techniques to maximize length of arterial conduits, knowledge of competitive flow and which moderate lesions should be addressed, complete revascularization with arterial grafts can be accomplished in the majority of patients, notwithstanding it may not be possible or even indicated for every patient.
