Prophylactic Left Internal Mammary Artery Graft In Mildly-Stenosed Coronary Lesions. Still An Open Discussion

Évora, Paulo Roberto Barbosa; Arcêncio, Livia; Schmidt, André; Rodrigues, Alfredo José

doi:10.5935/abc.20160032

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…However, there remain intense debate on whether to graft moderately stenotic coronary arteries. More recently, the concept of “prophylactic” grafting has emerged as an option for patients with even mildly stenotic lesions but with concomitant severe medical illness [ 59 ]. In those patients, their minimally diseased vessels are expected deteriorate with time, and the risk from reoperation increases.…”

Section: Competitive Flowmentioning

confidence: 99%

Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

Samak

Fatullayev

Sabashnikov

et al. 2016

Med Sci Monit Basic Res

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Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience.

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Section: Competitive Flowmentioning

confidence: 99%

Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

Samak

Fatullayev

Sabashnikov

et al. 2016

Med Sci Monit Basic Res

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“…[ 19 ] In contrast, the concept of “prophylactic” grafting has emerged as an option for patients with even mildly stenotic lesions but with concomitant severe medical illness. [ 20 ] In these patients, the minimally diseased vessels are expected to deteriorate with time and the risk from reoperation increases.…”

Section: Discussionmentioning

confidence: 99%

Total Arterial Off-Pump Coronary Artery Bypass Grafting

Yuan

Zhao

et al. 2018

Chinese Medical Journal

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Background:Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.Methods:From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.Results:The average distal anastomosis was 2.34 ± 0.97 (range: 1–4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.Conclusions:Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.

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“…Thus, to graft a moderately stenosed coronary vessel with LITA remains debatable, keeping the question proposed by Hayward and colleagues open: “Should all moderate coronary lesions be grafted during primary coronary bypass surgery?” [7]. Moreover, controversy exists whether LITAs should be used to bypass coronary arteries with noncritical stenosis.…”

Section: The “Prophylactic” Left Internal Thoracic Artery Graft In MImentioning

confidence: 99%

“…It has been well established that coronary venous grafts in arteries with moderate atherosclerotic lesions (<70%) had early occlusion mainly due to flow competition with the anterograde flow in the native coronary circulation. Thus, to graft a moderately stenosed coronary vessel with LITA remains debatable, keeping the question proposed by Hayward and colleagues open: “Should all moderate coronary lesions be grafted during primary coronary bypass surgery?” [ 7 ]. Moreover, controversy exists whether LITAs should be used to bypass coronary arteries with noncritical stenosis.…”

Section: The “Prophylactic” Left Internal Thoracic Artery Graft In MImentioning

confidence: 99%

Speculative Considerations about Some Cardiology Enigmas

Évora

Schmidt

Arcêncio

et al. 2017

CCR

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Background:Enigmas often lead to hypotheses and speculations. For this reason, especially for the sake of the reader’s motivation, we opted for the plain discussion of some cardiology enigmas.Objective:The present text was aimed to discuss speculatively some cardiology enigmas.Method:Text was freely designed in the context of coronary artery and heart valve diseases.Results:The results were presented as the combination enigma/hypothesis. 1) The absence of arteriosclerosis in intramyocardial coronary arteries/ endothelium-myocardial interaction (crosstalk); 2) The unique and always confirmed superior evolution of the internal thoracic artery as coronary graft/ higher NO basal release 3) The prophylactic left internal thoracic artery graft in mildly-stenosed coronary lesions/need of more accurate functional imaging techniques; 4) The high incidence of perioperative atrial fibrillation in patients with coronary artery disease/atrial ischemia associated to left circumflex coronary lesions; 5) The handling of disease-free saphenous vein grafts at the time of re-operation/biological serendipity with graft vein segments; 6) The possible aortic stenosis protection against coronary artery disease/ endothelium myocardium interaction (crosstalk) improving NO release.Conclusion:The discussed topics associated with their respective speculative hypothesis remain as enigmas, but would become motivations for investigations

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Prophylactic Left Internal Mammary Artery Graft In Mildly-Stenosed Coronary Lesions. Still An Open Discussion

Cited by 4 publications

References 8 publications

Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

Total Arterial Off-Pump Coronary Artery Bypass Grafting

Speculative Considerations about Some Cardiology Enigmas

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