Sequential In Situ Left Internal Thoracic Artery Grafting to the Circumflex and Right Coronary Artery Areas

Bakay, Cihat; Onan, Burak; Korkmaz, Askin Ali; Onan, Ismihan Selen; Özkara, Ahmet

doi:10.1016/j.athoracsur.2012.08.053

Cited by 21 publications

(18 citation statements)

References 23 publications

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“…Nonskeletonized ITA grafts were then used. 14 Consistent with other authors, 14,16,17 we have been using extended ITA grafts elongated by a single postbifurcation branch on a routine basis. 14,16 Recent angiographic data attest to the feasibility of this approach, best exemplified by a 95% patency rate of extended ITA grafts at 28 months, comparable with the patency of standard (nonelongated) grafts.…”

Section: Discussionsupporting

confidence: 81%

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Concomitant Grafting of Both Postbifurcation Internal Thoracic Artery Branches

Sahar

Wolak

Matsa

et al. 2015

Innovations�(Phila)

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Objective We aimed to assess the clinical outcome and graft patency after concomitant grafting of both postbifurcation internal thoracic artery (ITA) branches. Methods Between 2007 and 2013, 17 patients (14 men; mean [SD] age, 60 [9.3] years) underwent skeletonized bifurcated ITA grafting. Respective targets were restricted to non–left anterior descending (LAD) area. in all patients, a complementary standard ITA was used to graft the LAD artery. Graft patency was assessed by standard coronary angiography or serial multidetector computed tomography. Results Of the bifurcated conduits, 94% were right ITA. Respective right ITA target sets were first and second obtuse marginal arteries (M1-M2) (n = 12), ramus-M1 (n = 2), and distal right coronary artery–posterior descending artery (n = 2). Right ITAs were mobilized retroaortic (via the transverse sinus) in 14 patients (82%) (to circumflex artery targets). Circumflex artery targets comprised 88.2% of all anastomoses (30/34). There were no early mortalities, myocardial infarctions, or hypoperfusion syndromes. During median follow-up of 44 months (range, 3–63), there was no late mortality. Overall reintervention rate was 11.7%, and bifurcated ITA–related reintervention rate was 5.8%. At 5 years, freedom from major adverse cardiac or cerebrovascular event related to bifurcated ITA respective territory was 87% (Kaplan-Meier). Coronary imaging was achieved in 76% of the patients (elective multidetector computed tomography, n = 9; symptoms-directed coronary catheterization, n = 4). Bifurcation branch patency rate was 88.4% (23/26) at a median of 3.5 years. Conclusions Grafting both postbifurcation ITA branches is technically feasible and may be selectively considered. Current observations are valid for skeletonized conduits and limited to non-LAD targets. These preliminary findings should be corroborated by larger data sets.

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Section: Discussionsupporting

confidence: 81%

“…8Y12 From a clinical standpoint, increased risk for early postoperative hypoperfusion syndromes and reduced late ITA patency rate have been linked to their inclusion in ITA bypass grafts. 17 The histological data have been inconclusive. Nonskeletonized ITA grafts were then used.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Grafting of Both Postbifurcation Internal Thoracic Artery Branches

Sahar

Wolak

Matsa

et al. 2015

Innovations�(Phila)

View full text Add to dashboard Cite

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“…Although previous studies have shown no difference in long-term survival or freedom from repeat revascularization between different BITA configurations [12][13][14][15][16][17][18][19][20], and although those studies have also shown that no particular configuration is associated with relatively favorable clinical outcomes, our study revealed that certain aspects of the configuration must be considered. The selection of the ideal BITA configuration should be based on technical factors associated with the individual patient.…”

Section: Kjtcvscontrasting

confidence: 83%

Outcomes and Patency of Complex Configurations of Composite Grafts Using Bilateral Internal Thoracic Arteries

Shih

Chung

Kim

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization.

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“…in CABG. 1,2,16 Some authors might argue in behalf of sharp dissection over electrocautery. Our ultrastructural findings suggest that using a scalpel and clips for ITA harvesting might have a positive impact on graft patency; however, this has not been proved.…”

Section: Discussionmentioning

confidence: 99%

Effect of Electrocautery on Endothelial Integrity of the Internal Thoracic Artery: Ultrastructural Analysis with Transmission Electron Microscopy

Onan¹,

Yeniterzi²,

Onan³

et al. 2014

Texas Heart Institute Journal

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The internal thoracic artery (ITA) is typically harvested from the chest wall by means of conventional electrocautery. We investigated the effects of electrocautery on endothelial-cell and vessel-wall morphology at the ultrastructural level during ITA harvesting. Internal thoracic artery specimens from 20 patients who underwent elective coronary artery bypass grafting were investigated in 2 groups. The ITA grafts were sharply dissected with use of a scalpel and clips in the control group (n=10) and were harvested by means of electrocautery in the study group (n=10). Each sample was evaluated for intimal, elastic-tissue, muscular-layer, and adventitial changes. Free flow was measured intraoperatively. Light microscopic examinations were performed after hematoxylin-eosin and Masson's trichrome staining. Transmission electron microscopy was used to evaluate ultrastructural changes in the endothelial cells and vessel walls of each ITA. In the sharp-dissection group, the endothelial surfaces were lined with normal amounts of original endothelium, endothelial cells were distinctly attached to the basal lamina, cytoplasmic organelles were evident, and intercellular junctional complexes were intact. Conversely, in the electrocautery group, the morphologic integrity of endothelial cells was distorted, with some cell separations and splits, contracted cells, numerous large cytoplasmic vacuoles, and no visible cytoplasmic organelles. The subendothelial layer exhibited disintegration. Free ITA flow was higher in the sharp-dissection group (P=0.04). The integrity of endothelial cells can be better preserved when the ITA is mobilized by means of sharp dissection, rather than solely by electrocautery; we recommend a combined approach.

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Sequential In Situ Left Internal Thoracic Artery Grafting to the Circumflex and Right Coronary Artery Areas

Cited by 21 publications

References 23 publications

Concomitant Grafting of Both Postbifurcation Internal Thoracic Artery Branches

Concomitant Grafting of Both Postbifurcation Internal Thoracic Artery Branches

Outcomes and Patency of Complex Configurations of Composite Grafts Using Bilateral Internal Thoracic Arteries

Effect of Electrocautery on Endothelial Integrity of the Internal Thoracic Artery: Ultrastructural Analysis with Transmission Electron Microscopy

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