Coronary Revascularization With the Left Internal Thoracic Artery and Radial Artery. Comparison of Short-Term Clinical Evolution Between Elective and Emergency Surgery

Abstract

70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels. RESULTS: The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P = .17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P = .48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P = .18). Intensive care unit and postoperative stay were similar in both groups. CONCLUSION: Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.]]>

Cartas

“…As only 5% of the resistance of the system is in the upstream segment of the microcirculation, the radius of the graft is of little relevance. This is in accordance with the findings of Nordgaard et al [6], which showed that the flow of sequential grafts is significantly higher than in isolated grafts and explains why the literature includes studies that show that the sequential grafts are equivalent [7][8][9][10][11] or better [12,13] than isolated grafts .…”

Técnica para retirada da artéria radial sem utilização de clipes hemostáticos e experiência clínica

“…There are few reports approaching the use of arterial grafts in emergency surgeries. Our team demonstrated that the CABG, when exclusively performed with LITA and RA, presents good short-and mid-term clinical evolution, as much in elective surgeries as in emergency surgeries, with RA patency of 84% in 4 years [3,4]. Several studies have demonstrated that different RA resection techniques present similar outcomes.…”

“…The incidence of perioperative AMI was expected for the procedure [1][2][3], and is even less if one considers only the cases in which this event was due to the RA. Additonally, the patients needed little or no vasopressor agent in the postoperative, suggesting that the dissection with electrocautery does not predispose to RA spasm or thrombosis.…”

“…The need of reoperation due to bleeding; 3. Incidence of AMI defined as: a) appearance of Qwave at minimum two contiguous derivations; b) elevation of creatine phosphokinase (CPK) MB fraction greater than three times of the normal value and between 10 to 20% of the respective CPK value [3]; and 4. Hospital mortality Wherever possible, the grafts were used with sequential anastomosis.…”

Elective vs Non-Elective Radial Artery Grafts: Comparing Midterm Results Through 64-Slice Computed Tomography

“…The mean number of LITA grafts per patient in the elective and non-elective groups were 1.17 and 1.38, respectively (p=0.17). This group is fully described elsewhere (22) and the main operative and post-operative characteristics of both groups are summarized in table 2. Of these 47 patients, 5 died from non-cardiac complications and 12 were unavailable at the time of writing (one patient described himself as asymptomatic, but could not afford the time to travel from his home town to the study center; 11 patients were not found).…”