| Giant leaps in surgical myocardial revascularisation. | |
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MedLine Citation:
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PMID: 20869314 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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There have been dramatic advances in Coronary Artery Bypass graft surgery over the past 45 years. Coronary artery bypass grafting with saphenous vein grafts, was a highly reproducible procedure effective in alleviating angina. Its usefulness was compromised by myo proliferative change and atheromatous changes in the saphenous vein grafts resulting in reduced graft patency (50-60%) and survival (60-70%) at 10 years. Introduction of the left internal thoracic artery to the left anterior ascending artery was a significant advance resulting in less recurrent angina, fewer cardiac events improved patency (> 90%) and survival (80-90%) 10 years postoperatively. The left internal thoracic artery to the left anterior descending artery and saphenous vein graft to other vessels remains the standard operation today. Off-pump coronary artery bypass grafting provides equivalent results in routine patients but is of particular value in those with a calcified or atheromatous ascending aorta. Bilateral internal thoracic arteries are better than one internal thoracic artery, especially in the 10-20 year time frame. Multiple arterial grafting and total arterial grafting, facilitated by the use of bilateral internal thoracic arteries, T or Y-Grafts, use of the radial artery, right gastroepiploic artery and sequential anastomosis are consistently associated with even further improvements in symptoms and prognosis with survival greater than 90% at 10 years despite increase in patient age and co morbidities in recent series. Overall patencies for other arterial grafts at 10 years are - the right internal thoracic artery 90%, the radial artery 89%, and the right gastroepiploic artery 70%. Contemporary randomised studies consistently show superior patencies for arterial grafts over saphenous vein grafting. In summary, the left internal thoracic artery to the left anterior descending artery is essential; two or more arterial grafts are preferable, especially to the left anterior descending and the circumflex, and total arterial vascularisation is ideal. |
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Authors:
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James Tatoulis |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Heart, lung & circulation Volume: 20 ISSN: 1444-2892 ISO Abbreviation: Heart Lung Circ Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-11 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100963739 Medline TA: Heart Lung Circ Country: Australia |
Other Details:
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Languages: eng Pagination: 149-56 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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Department of Cardiac Surgery, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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