Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits

Calafiore, Antonio M.; Vitolla, Giuseppe; Iacò, Angela L.; Fino, Carlo; Giammarco, Gabriele Di; Marchesani, Francesco; Teodori, Giovanni; D’Addario, Giancarlo; Mazzei, Valerio

doi:10.1016/s0003-4975(99)00282-9

Cited by 187 publications

(107 citation statements)

References 19 publications

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“…Patients who received skeletonized BIMA grafts had significantly more distal anastomoses per patient than those who had pedicle BIMA. 10 We believe that the greater the number of arterial grafts, the better the outcome, and we always aim at complete arterial grafting with exclusive use of the theoretically best conduits, namely, in situ arterial grafts, whenever anatomically possible. 6 Graft selection avoiding size discrepancy between the native coronary artery and the graft and choosing the best anastomotic site are 2 important surgical factors to prevent early graft occlusion.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

2003

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Background-This historical cohort study evaluated the benefit of bilateral internal mammary artery (BIMA) grafts in coronary bypass grafting (CABG) for patients with diabetes. Methods and Results-We performed elective, isolated, primary, multiple CABG using skeletonized internal mammary artery (IMA) grafts for multivessel disease in 1131 patients, 467 (41.3%) of whom had type 2 diabetes mellitus. The early and long-term results were compared between 277 patients with diabetes using single IMA (SIMA) grafts and 190 using BIMA grafts (median follow-up, 8.1 years). Hospital mortality was similar in both groups. Early patency rate of all grafts was significantly higher using BIMA than using SIMA (97.7% versus 93.8%, Pϭ0.0012). Survival rates were not significantly different between SIMA and BIMA groups. Late cardiac mortality was significantly higher in patients with low ejection fraction (0.4 or lower) compared with preserved ejection fraction (higher than 0.4) (Pϭ0.0001). In patients with preserved ejection fraction, 10-year survival rate was significantly higher using BIMA than using SIMA (87.8Ϯ3.5% versus 75.2Ϯ3.4%, Pϭ0.04), and 10-year all death-free or repeat CABG or recurrent myocardial infarction-free rate was significantly higher using BIMA than using SIMA (86.6Ϯ3.6% versus 69.0Ϯ3.7%, Pϭ0.0086).The hazard ratio for all death or repeated CABG or recurrent myocardial infarction in patients with preserved ejection fraction was markedly lower in the BIMA group (0.53; 95% CI, 0.31 to 0.9; Pϭ0.019). Conclusions-Skeletonized

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Section: Discussionmentioning

confidence: 99%

Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

2003

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“…Harvesting of the ITA in skeletonized fashion reduces the risk of sternal complications, particularly in diabetic patients, 18,19 and decreases the time for pulmonary recovery. 20 With direct visual control of the graft, the recognition of damage, such as dissection, is easily possible.…”

Section: Discussionmentioning

confidence: 99%

“…20 With direct visual control of the graft, the recognition of damage, such as dissection, is easily possible. In addition, the resulting increases in length and graft diameter 19 make the construction of sequential anastomoses easier. Free flow in these skeletonized ITA grafts is significantly higher compared with that in the conventional pedicled ITA graft, 21 which can be expected to reduce the incidence of ITA hypoperfusion syndrome.…”

Section: Discussionmentioning

confidence: 99%

Complete Arterial Revascularization in Multivessel Coronary Artery Disease With 2 Conduits (Skeletonized Grafts and T Grafts)

Wendler

Hennen²,

Demertzis³

et al. 2000

Circulation

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Background-Complete arterial CABG is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma. By use of new operative techniques (skeletonized grafts and the T-graft approach), CABG in multivessel CAD is now possible with only 2 grafts. We present our experience in the use of these techniques on a routine basis. Methods and Results-Between March 1996 and September 1999, 490 patients (aged 61Ϯ9 years, 20% female) underwent complete arterial CABG. Left ventricular ejection fraction ranged from 15% to 85% (mean 59Ϯ15%). Triple-vessel disease was present in 88% of the patients. The incidence of diabetes mellitus was 32% (14% insulin dependent). Either both internal thoracic arteries (ITAs) (23%) or the left ITA and radial artery (77%) were used as conduits. In 85% of the patients, a T graft was created. Mean operating time was 198Ϯ46 minutes; bypass time, 82Ϯ25 minutes; and ischemic time, 58Ϯ22 minutes. Two to 7 (mean 4.1Ϯ0.9) anastomoses were performed per patient. Perioperative intra-aortic balloon pump was necessary in 12 patients (2.4%). The rate of perioperative myocardial infarction was 1.2%. Sternal complications occurred in 1.0%, and in-hospital mortality was 2.2%. Postoperative coronary angiography in 172 patients (35%) documented excellent patency rates (left ITA 98.3%, right ITA 96.5%, and radial artery 96.6%). Conclusions-Complete

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“…MENEZES, AM ET AL -Technical aspects in skeletonization of the internal thoracic artery using an ultrasonic scalpel the morbimortality between the utilization of only one ITA or of both [19][20][21][22][23]. In our series, no cases of infections (osteomyelitis or mediastinitis) were observed even though electrocautery and bone wax were used for sternal hemostasis, when necessary.…”

Section: -Final Aspect Of Skeletonized Internal Thoracic Arterymentioning

confidence: 72%

Aspectos técnicos na esqueletização da artéria torácica interna com bisturi ultra-sônico

Menezes¹,

Vasconcelos²,

Lima³

et al. 2007

Rev Bras Cir Cardiovasc

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Bilateral internal mammary artery grafting: midterm results of pedicled versus skeletonized conduits

Cited by 187 publications

References 19 publications

Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

Bilateral Versus Unilateral Internal Mammary Revascularization in Patients With Diabetes

Complete Arterial Revascularization in Multivessel Coronary Artery Disease With 2 Conduits (Skeletonized Grafts and T Grafts)

Aspectos técnicos na esqueletização da artéria torácica interna com bisturi ultra-sônico

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