BACKGROUND: The purpose of the study was to measure the blood flow in coronary artery bypass grafting conduits on-pump and off-pump and to estimate the total conduit flow. METHODS: In a 3.5-year period, 120 patients having coronary artery bypass grafting on-pump and 97 patients having coronary artery bypass grafting off-pump ...

BACKGROUND: To compare survival of patients receiving bilateral internal thoracic artery grafts and single internal thoracic artery grafts more than 20 postoperative years, assess magnitude of benefit, and identify predictors of benefit. METHODS: From cohorts of 8123 patients receiving single internal thoracic artery grafts and 2001 receiving bilateral internal thoracic ...

BACKGROUND: Robotically enhanced telemanipulation surgery is a fast developing technique which allows totally endoscopic cardiac surgery with utmost precision and perfection on both beating heart as well as arrested heart. METHODS AND RESULTS: Between December 2002 and February 2004, 125 patients underwent robotically enhanced coronary artery bypass surgery using the ...

BACKGROUND: A new technique has been developed that permits complete arterial revascularization of the lateral and/or inferior wall of the heart using in situ bilateral internal thoracic artery grafts in awake patients. This technique, without cardiopulmonary bypass and mechanical ventilation, creates the least invasive revascularization method for the lateral and/or ...

A method of total arterial revascularization is presented. This technique is based on the extension of a semi-skeletonized right internal thoracic artery graft with an entire radial artery in an end to end fashion. A complete arterial revascularization is achieved with a bilateral in situ internal thoracic artery strategy preserving ...

STUDY OBJECTIVES: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the dipyridamole stress test (DSST) in predicting > or = 50% obstruction of an internal mammary artery or new native coronary artery disease (CAD) compared with saphenous vein graft obstruction > or = ...

Some morphological characteristics of the variable thyroid ima artery were investigated on the injected fetal arteries and explained on their 106 static images. Thyroid ima artery of different origin was proven in 18 (16.9%) cases. With respect to the vascular sources of the investigated artery, the branching of the brachiocephalic ...

We present a technique for replacement of the aortic valve in selected patients undergoing redo surgery in the presence of patent coronary artery bypass grafts and occluded native coronary arteries that affords optimal myocardial protection, limited dissection of the heart and minimal risk of injury to existing grafts, in particular, ...

BACKGROUND: Left internal mammary artery spasm is well recognized during coronary artery bypass operations. Papaverine has been used by many surgeons to maximize mammary artery flow perioperatively, but the best delivery method is not known. We analyzed two techniques used at our institution. METHODS: Fifty-eight patients were randomized into three ...

Clinical applications for the internal mammary artery include use as an arterial conduit for coronary revascularization and as a recipient artery for microvascular reconstruction of the breast. This study was completed in an attempt to resolve the controversy over which indication should have priority. Five hundred twenty women with breast ...

BACKGROUND: Internal mammary artery conduits (IMA) have an excellent long-term patency rate. Nevertheless, graft closure does occur and significantly limits future revascularization options. We sought to investigate the relationship between the long-term patency of IMA with clinical and angiographic parameters. Particularly, the preoperative degree of stenosis of the relevant bypassed ...

BACKGROUND: This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows. METHODS: We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive ...

We report about a 72-year-old woman with coronary artery disease. Surgical revascularization was performed using three grafts. One of them was the right internal thoracic artery (RITA) to left anterior descending. This graft was covered by a PRECLUDE IMA Sleeve. Wound healing was impaired and became to a chronic sternal ...

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to ...

In the past decade the rate of reoperative coronary bypass grafting has averaged 8%. In these patients adequate myocardial protection is often difficult because delivery of cardioplegia is frequently suboptimal when the internal mammary artery graft is patent. We describe a simple technique for performing cardiac reoperation in patients with ...

OBJECTIVES: The aim of this study was to evaluate the early postoperative outcome in patients undergoing "omega-anastomosis" construction, a technique that permits revascularization of coronary bifurcations employing a single arterial graft. MATERIALS AND METHODS: Between January 2000 and March 2002, omega-anastomosis was employed in 12 patients. The main indication for ...

OBJECTIVE: This study was performed to validate noninvasive transthoracic Doppler ultrasound (TTD) with simultaneous invasive Doppler guidewire measurements in patients after minimal invasive direct coronary artery bypass operation. METHODS: A total of 14 patients were examined 3 to 8 days after minimal invasive direct coronary artery bypass operation. TTD was ...

This study aimed to evaluate the risk factors for sternal wound complications in patients undergoing myocardial revascularization using bilateral semi-skeletonized internal mammary arteries. Prospectively collected data on 751 patients undergoing coronary artery surgery from September 1994 to August 2002 were analyzed. The mean age of the patients was 56 years, ...

Chylothorax is a rare complication following coronary artery bypass graft surgery. In the following case, we report a chylothorax complicating left internal mammary artery harvesting due to injury of the left anterior mediastinal lymph node chain (LAMLNC) at the level of the proximal pedicle of the mammary artery. Re-expansion pulmonary ...

OBJECTIVE: There is concern about the quality of the distal anastomosis in off-pump coronary artery bypass grafting. We investigated the impact of specific construction errors on anastomotic geometry using epicardial ultrasound. METHODS: Twelve ex vivo pressure perfused porcine and five isolated post-mortem human hearts were used to construct 35 internal ...

Proximal anastomotic devices for beating heart coronary artery bypass grafting (CABG) have been developed to avoid ascending aortic manipulation. Distal anastomotic devices may become an extremely useful tool to assist in enabling minimally invasive (robotic) multivessel CABG. As a transition phase toward this ultimate goal we have been using a ...

OBJECTIVE: To determine the tissue content and endothelin-receptor characteristics of endothelin-1 in the radial artery in relation to the internal mammary artery. DESIGN: Endothelin-1 content was quantified in the radial artery and the internal mammary artery. Both arteries were exposed to endothelin-1 and agonists of the endothelin A and B ...

Pseudoxanthoma elasticum (PXE) is a rare, inherited connective tissue disorder with numerous systemic manifestations that include premature coronary artery disease. Coronary artery bypass grafting (CABG) is known to be beneficial in patients with PXE-related coronary artery disease. In these patients, however, the suitability of arterial conduits, including the internal mammary ...

BACKGROUND: The left internal mammary artery to the left anterior descending artery is recognized as the gold standard for revascularization. Several studies have shown the benefits of the left internal mammary artery. However, a substantial portion of patients undergoing coronary artery bypass grafting does not receive this conduit. We sought ...

In patients undergoing chronic hemodialysis (HD) through an arm arteriovenous fistula (AVF), coronary insufficiency can occur if the patient undergoes a coronary artery bypass graft (CABG) using the ipsilateral internal mammary artery (1-4). Therefore, the creation of a new AVF after CABG should avoid using the arm ipsilateral to the ...

New lesions appearing during coronary angioplasty may be due to spasms, dissection, and thrombosis. Straightening of the tortuous vessels by guidewire may produce transient angiographic pseudo-lesions, which mimic severe artery damage. An additional case is reported, in which simultaneous artifactual lesions involved the internal mammary artery and the left anterior ...

Left internal mammary artery (LIMA) has the best long-term patency in patients undergoing coronary artery bypass surgery. Stenosis of the proximal left subclavian artery (SA) may reduce flow to the LIMA, causing myocardial ischemia. We report a novel technique (crush stenting) for the treatment of a complex bifurcational left SA-vertebral ...

During the past 6 years, 50 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of a narrowed coronary anastomosis of a left internal mammary artery (LIMA) graft or PTCA of a left anterior descending coronary artery stenosis via LIMA grafts at the investigators' institution. The success rate was high at 88%. ...

Traditionally, the internal thoracic artery is harvested as a pedicle. In contemporary cardiac surgical practice, however, certain surgeons practice the internal thoracic artery-skeletonization technique. A systematic review of clinical studies reporting on the use of skeletonized internal thoracic arteries (SKT-ITA) has not yet been performed. The primary aim of this ...

The use of internal mammary artery is well established not only in cardiac surgery for coronary artery bypass grafting but also in plastic surgery for breast reconstruction with free autologus tissue. The complications that follow harvest of internal mammary artery for heart surgery usually relate to the wound. This case ...

This case report presents the first totally endoscopic coronary artery bypass performed with a robotic system in Italy at the Department of Cardiovascular Surgery of Padua University in December 2001. A 66-year-old male, with an indication to a single bypass of the left anterior descending coronary artery using the left ...

This paper describes a new technique for microvascular anastomosis, which involves the overlapping of the adventitias of the two ends of a severed blood vessel, and then painting a cyanoacrylate adhesive on the outer surface of the vessel around the anastomosed part. Sixteen anastomoses were performed in both radial arteries ...

Tension on the internal mammary artery is a major risk for anastomosis in patients with severe emphysematous lungs. For this reason, it can be necessary to harvest the internal thoracic artery to its origin, to skeletonize it, or as a last resort to use it as a free graft. Sometimes, ...

PURPOSE: Stenosis and occlusion rates of internal mammary artery (IMA) and saphenous vein (SV) coronary artery bypass grafts (CABGs) are markedly different, which result from respective disparities in vascular remodeling. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) regulate vascular structure and may have important influence on graft patency. ...

The haemodynamic effects of a continuous infusion of milrinone without an initial bolus dose were evaluated in patients undergoing off-pump coronary artery bypass graft surgery. After internal mammary artery harvest, milrinone 0.5 microg.min(-1).kg(-1) (29 patients) or a normal saline infusion (33 patients) was started and continued until all graft anastomoses ...

The lateral costal artery (LCA), a supernumerary branch of the internal thoracic artery (ITA), occurs in several ethnic groups on one side of the thorax or on both, in 15-30% of cases. It has been considered responsible for the "steal-syndrome" of the coronary blood after coronary artery bypass grafting and ...

AIM: The left internal mammary artery is the graft of choice for coronary artery bypass surgery. The necessity for preoperative internal mammary artery angiography is still controversial. We designed a prospective left internal mammary angiography for evaluating the risk of stenosis in the left internal mammary and subclavian artery, and ...

BACKGROUND: This study was designed to compare the effect of surgical harvesting on internal thoracic artery innervation and to assess the eventual presence of denervation supersensitivity in skeletonized grafts. METHODS: Nineteen patients who underwent primary isolated coronary artery bypass grafting were randomly assigned to receive a skeletonized (n = 9) ...

BACKGROUND: This review presents an overview of interventional revascularization procedures of the internal thoracic artery after prior implantation as a coronary-artery bypass graft. METHODS: Our search was concentrated on the MEDLINE-database to identify all articles on internal thoracic artery-graft-angioplasties and reoperation after internal thoracic artery bypass grafting published between 1968 ...

BACKGROUND: The advantages of internal thoracic artery skeletonization include early high blood flow, a longer conduit, and less bleeding than pedicle internal thoracic artery grafts. Longer conduits are needed for complete endoscopic arterial revascularization. Therefore this study was designed to determine the feasibility and safety of internal thoracic artery skeletonization ...

Coronary artery dissection is a well-described but rare complication of diagnostic angiography. With increased numbers of patients undergoing coronary artery bypass grafting, the number of patients undergoing repeat angiography for chest pain should likewise increase. The authors report two cases of catheter-induced left internal mammary (LIMA) dissection and review the ...

Retrosternal pericardial adhesion formation constitutes a major hazard during re-do coronary artery surgery. To determine whether an onlay parietal pleural flap over the internal thoracic artery bed would reduce pericardial adhesions after coronary artery grafting, 16 sheep underwent a median sternotomy and both internal thoracic arteries were harvested. On the ...

The internal mammary artery (IMA) is the conduit of choice in coronary revascularization because of its long-term patency. We analyzed the effect of left internal mammary artery (LIMA) harvesting on sternal perfusion. Diameters and velocity parameters of the nonmobilized right internal mammary artery (RIMA) were noninvasively analyzed with duplex ultrasound ...

OBJECTIVE: The skeletonized internal thoracic artery (ITA) has several advantages over a pedicled one in coronary artery bypass grafting (CABG). An ultrasonic scalpel makes ITA skeletonization easy and speedy, however, the ultrasonic energy that is transmitted to the artery itself can occasionally injure the endothelium. Therefore, the endothelial integrity of ...

Select patients who have undergone orthotopic heart transplantation with proximal left anterior disease may be candidates for minimally invasive direct coronary artery bypass surgery. Combining left internal thoracic artery transthoracic Doppler flow assessment with wall motion assessment during dobutamine stress echocardiography adds to the utility of this test by focusing ...

BACKGROUND: Trends in coronary artery bypass (CAB) and valve operations (VO) may help predict the future of cardiac surgery in the context of changing case mix, shifting paradigms, emerging technology, and population demographics. METHODS: We retrospectively reviewed all 30,319 adult CAB and VO in our group from 1979 to 1999 ...

Congenital fistulas from the left internal mammary artery to the pulmonary artery are rare. We describe a 49-year-old patient with severe aortic valve regurgitation and coronary artery disease. Percutaneous transluminal coronary angioplasty and left anterior descending artery (LAD) stenting had been performed because of a significant proximal LAD lesion. Repeated ...

Because of the extensive use of arterial conduits for coronary surgery there is a growing interest in percutaneous intervention in these conduits. This kind of intervention presents a challenge for the interventional cardiologist owing to the anatomic and functional characteristics of this graft. In most cases significant internal mammary artery ...

PURPOSE: This article describes our clinical experience with a new needle driver (Olympus, Tokyo, Japan), which we have produced to facilitate minithoracotomy or port-access coronary artery anastomosis with the running suture technique. METHODS: The needle driver is 21 cm long, weighs 38 g, and has a grip shaft 1.4 cm ...

Percutaneous transbrachial insertion of two complex coils into the intercostal branch of the left internal mammary artery resulted in the relief of severe angina in a 45-year-old man who had coronary artery bypass surgery 2 years before. The diagnosis of coronary artery steal was made clinically. This case illustrates the ...