Document Detail


Giant leaps in surgical myocardial revascularisation.
MedLine Citation:
PMID:  20869314     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
James Tatoulis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart, lung & circulation     Volume:  20     ISSN:  1444-2892     ISO Abbreviation:  Heart Lung Circ     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963739     Medline TA:  Heart Lung Circ     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  149-56     Citation Subset:  IM    
Copyright Information:
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:
Department of Cardiac Surgery, Royal Melbourne Hospital, Parkville, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, Australia.
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