Fig 3 - uploaded by Akihito Sasaki
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The left internal thoracic artery (LITA) anastomosed to the highlateral branch (HL) and the terminal branches of the LITA anastomosed seperately to the first and second posterolateral branches (PL 1 and PL 2 ) in a “Y” fashion.
Source publication
Recently off-pump coronary artery bypass grafting (CABG) is being widely used for coronary revascularization. However, there is some evidence that off-pump surgery increases the risk of recurrent angina and the need for reintervention, suggesting poor graft quality or incomplete revascularization. We describe our experience to demonstrate the feasi...
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Introduction:
We report two cases of off-pump coronary artery bypass grafting (CABG) with celiac artery (CA) or superior mesenteric artery (SMA) stenosis using skeletonized gastroepiploic artery (GEA) grafts.
Presentation of case:
A 77-year-old man (case 1) and a 49-year-old man (case 2) underwent off-pump CABG for unstable angina. Preoperative...
We performed early postoperative angiography to assess anastomosis accuracy and patency after off-pump coronary artery bypass grafting.
One thousand three hundred forty-five patients who underwent off-pump coronary artery bypass grafting between January 1998 and December 2007 were studied. Grafts for distal anastomoses were left internal thoracic a...
Background:
Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery (CABG), in which the left internal mammary artery (LIMA) is typica...
Here we report a rare case of atypical Kawasaki disease (KD) in a patient presenting with systemic arteritis affecting the coronary arteries, brain, and internal mammary arteries (IMAs). A 25‐year‐old man was referred to our institute with angina pectoris. Coronary angiography revealed coronary artery aneurysms and triple‐vessel disease. Three‐dime...
Skeletonized arterial grafting may reduce the risk of graft spasm and may improve graft patency. Previously we reported a pilot study of skeletonized gastroepiploic artery (GEA) grafting with favorable results. Skeletonized GEA harvesting with an ultrasonic scalpel has now become our routine procedure. In this report, we compare the early clinical...
Citations
... T he Starfish Heart Positioner (Medtronic, Inc.; Minneapolis, Minn) aids off-pump coronary artery surgery in adult patients. 1 Use of the device enables hands-free manipulation of the heart, thereby preventing coronary artery compression and permitting exposure of the posterior surface of the heart without incurring ischemia. Here, we describe the use of a Starfish Heart Positioner in a 17-month-old girl who had a right coronary artery-to-right ventricular fistula. ...
... [10][11][12] Animal studies involving the Starfish have revealed minimal changes in stroke volume and intracardiac pressure upon cardiac displacement of up to 90°. 13 These features have made the Starfish useful in off-pump coronary artery surgery in adult human patients. 1 The Starfish has been used to expose the posterior cardiac surface to facilitate the ligation of a coronary fistula in an adult, thus avoiding the use of cardiopulmonary bypass, 14 and we have reported herein this application in a 9-kg child. We experienced no technical difficulty with the device; however, the size limitation for its use in pediatric patients is not known. ...
The Starfish Heart Positioner aids off-pump coronary artery surgery in adult patients by providing posterior cardiac exposure without incurring hemodynamic instability. Herein, we describe its use in a 17-month-old girl who had a right coronary artery fistula that drained to the right ventricle. Use of the device enabled exposure that afforded closure of the fistula without cardiopulmonary bypass. The patient was discharged from the hospital 2 days postoperatively. Six weeks later, she was well, and echocardiography showed no residual fistulous flow.
... Similarly, Nathoe and colleagues demonstrated equivalent graft patency between CABG and OPCAB 1 year following revascularization (60). Furthermore, complete, multivessel revascularization has demonstrated 96.6% patency 1 month following OPCAB (61). One year following OPCAB, patency for saphenous vein grafts has been 87%, and IMA grafts have demonstrated nearly 96% patency (62). ...
Coronary artery disease is a global health concern, with increasing morbidity and mortality. Surgical coronary artery bypass grafting has been performed on cardiopulmonary bypass for nearly four decades, with excellent long-term durability. Beating-heart coronary surgery has been increasing in frequency in an attempt to decrease cardiopulmonary bypass-related morbidity. Furthermore, with increasing expertise and technology, minimally invasive and robotic techniques have been developed to enhance post-operative recovery, patient satisfaction and cosmesis. Several clinical trials have demonstrated decreased morbidity and more rapid recovery following off-pump, minimally invasive and robotic procedures when compared to on-pump coronary artery bypass grafts (CABGs). An equivalent extent of revascularization and medium-term anastomotic patency has been demonstrated among all approaches. Furthermore, for a large number of patients who do not have anatomy amenable to traditional coronary revascularization, adjunctive molecular therapies may provide alternative myocardial micro-revascularization.
Background:
The optimal conduit choice in revascularisation of the right coronary system (RCA) remains uncertain. This study aims to identify if arterial grafts are superior to saphenous vein (SV) grafts and whether graft failure rates vary between proximal and distal RCA anastomoses.
Methods:
29 studies identified by systematic review were analysed for study quality and length of follow-up using Bayesian hierarchical random effects modelling. Heterogeneity was assessed and sensitivity analysis performed. Primary endpoints were graft patency at early, mid and late-term follow-up when compared with SV grafts.
Results:
There was no difference in early failure of radial artery (RA) or right gastroepiploic artery grafts when compared with SV (OR 0.82, 95% CI (0.14 to 2.68) and OR 1.19 (0.08 to 4.66), respectively). However, mid-term ORs based on observational study data demonstrated increased graft failure with right gastroepiploic artery and right internal thoracic artery compared with SV (OR 2.76 (1.26 to 5.48) and OR 2.07 (0.96 to 3.98), respectively), although right internal thoracic artery did not achieve statistical significance. No significant difference was observed in late graft failure for RA compared with SV (OR 0.47 (0.09 to 1.41)) without study-type disparity. However, simplified statistical pooling revealed significantly lower graft failure was observed with RA grafts to the proximal RCA when compared with SV (χ2 6.15, p = 0.01).
Conclusions:
Arterial grafts do not demonstrate a beneficial reduction of angiographic graft failure when compared with SV grafts on the RCA with the exception of RA to the proximal RCA. Future research should focus on clinical and patient-reported endpoints to identify any benefits of RCA arterial revascularisation.
The right gastroepiploic artery (RGEA) has been used as a conduit in coronary artery bypass grafting. Although some reports presenting good results justify its use in clinical settings, there is still much concern about using the RGEA in bypass surgery. The RGEA demonstrates different behaviors from the internal thoracic artery (ITA) in bypass surgery due to its histological characteristics and anatomical difference, which might contribute to the long-term outcome. Now that left ITA (LITA) to left anterior descending artery (LAD) is the gold standard, other grafts are expected to cover the rest of the coronary arteries. It should be elucidated how we can use other grafts and what we can expect from them. RGEA, as an arterial graft, can be used as an in situ graft or a free graft. The RGEA is mainly used to graft to the right coronary artery (RCA) because of its anatomical position, and its patency is not inferior to that of the saphenous vein (SVG). The RGEA can cover the lateral walls when its length is long enough or by making a composite graft with other grafts. However, when used to graft to the LAD, its mid-term patency is not favorable.
