Midterm Results of Free Internal Thoracic Artery Grafting for Myocardial Revascularization

Tashiro, Tadashi; Nakamura, Katsuhiko; Sukehiro, S; Nakamura, Masanao; Shibano, Ryuichi; Motomura, Tadashi; Kimura, Michio

doi:10.1016/s0003-4975(97)01417-3

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Controversies exist regarding the patency rate when RITA is used as a free graft from the ascending aorta. Although Tashiro et al 28 showed comparable patency between free RITA and in situ RITA, several other authors have reported that the patency of the RITA as a free graft was lower than the patency of an in situ RITA, 29,30 probably due to differences in nitric oxide release.…”

Section: Resultsmentioning

confidence: 93%

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

et al. 2020

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Background and Aim of the Study: Although abundant biological, clinical, and scientific evidence exists on the superiority of multi-arterial (MAR) and total-arterial revascularization (TAR) over the conventional strategy with a single internal thoracic artery, only 10% of patients undergoing coronary artery bypass grafting (CABG) in the United States receives a second arterial conduit, and only 5% of patients receives TAR. Methods and Results: In January 2020, the authors performed comprehensive search to identify studies that evaluated MAR and TAR strategies through the MEDLINE database. Conclusions: In this paper, the authors reviewed the literature on the historical and current evidence in favor of MAR and TAR, thus underlying why current CABG practice needs qualitative improvement. K E Y W O R D S CABG, coronary artery bypass grafting, coronary artery disease, multiarterial revascularization, total arterial revascularization

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Section: Resultsmentioning

confidence: 93%

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

et al. 2020

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“…The immediate postoperative patency rate was 95.2% (40/42) and the long-term (mean 94.8 months) was 100% (25/25). 28 In summary, the majority of modern available data supports the use of the free ITA as a conduit that can provide excellent long-term patency that is comparable to an in situ LITA, ie, >90%. Technical considerations of the proximal anastomosis are critical and must be left up to the individual surgeon's expertise and judgment.…”

Section: Efficacy Of Free Ita Graftsmentioning

confidence: 83%

“…Finally, in a study by Yamashiro et al, 41 patients with 42 distal anastomoses utlilizing free ITA were evaluated angiographically. The immediate postoperative patency rate was 95.2% (40/42) and the long‐term (mean 94.8 months) was 100% (25/25) 28 …”

Section: Efficacy Of Free Ita Graftsmentioning

confidence: 97%

“…In a prospective study, using routine follow-up angiography not related to symptoms, Tashiro et al compared free ITA to in situ ITA in 337 patients. 27 Early angiographic follow-up was performed at a mean of 32.4 days with a free ITA patency of 93.2% (68/73) and in situ ITA patency of 96% (337/352). Mid-term angiographic follow-up at a mean of 29.5 months demonstrated a free ITA patency of 100% (25/25) and in situ ITA patency of 92.1% (82/89).…”

Section: Efficacy Of Free Ita Graftsmentioning

confidence: 99%

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Diagnosis and Management of Subclavian Artery Stenosis Prior to Coronary Artery Bypass Grafting in the Current Era

Rogers¹,

Calhoun

2007

J Cardiac Surgery

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There are several approaches to managing subclavian artery stenosis (SAS) prior to coronary artery bypass grafting (CABG) with an intended internal thoracic artery (ITA) graft to the left anterior descending (LAD) artery. We herein review the incidence of and various diagnostic modalities for detecting SAS. Published relevant clinical studies from the interventional cardiovascular and cardiac surgical literature are summarized. Particular emphasis is placed on the efficacy of various approaches to the patient diagnosed with SAS prior to CABG. Stenting the subclavian artery prior to bypass surgery and using an in situ ITA is compared to using the ITA as a "free" graft. The incidence of restenosis after subclavian artery angioplasty or stenting is not trivial and has been reported to occur at a rate of 6% to 21%; however, the average rate of restenosis with stenting appears to be in the mid-teens. Subacute subclavian stent thrombosis or occlusion is exceptionally rare, suggesting that a percutaneous approach to SAS is reasonable prior to CABG. For patients requiring emergent revascularization, placement of a free ITA graft to the LAD appears to be a safe and durable treatment as patency rates are comparable to that of an in situ LITA to the LAD. In summary, although no randomized clinical trials address the optimal management of SAS prior to CABG, both percutaneous and surgical options appear to be safe and reasonably durable.

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“…A ocorrência de reestenose em várias séries é menor que 10% e a ocorrência de trombose é rara [21][22][23] . A conduta terapêutica em pacientes que necessitam de CRM em caráter de urgência deve considerar a utilização da artéria torácica interna direita (artéria mamária direita) ou da artéria torácica interna esquerda (artéria mamária esquerda) como enxerto livre, o que parece assegurar índices de patência comparáveis aos do enxerto in situ para a artéria descendente anterior [24][25][26] .…”

Section: Discussionunclassified

Prevalência de estenose da artéria subclávia em pacientes candidatos a cirurgia de revascularização do miocárdio: registro multicêntrico

Gomes

Roman

Barcellos

et al. 2008

Rev. Bras. Cardiol. Invasiva

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Prevalence of Stenosis of the Left Subclavian Artery in CABG Candidates: A Multicenter Registry Background: Approximately 90% of the patients submitted to coronary artery bypass graft surgery (CABG) receive a left internal thoracic artery (LITA) graft. Stenosis of the left subclavian artery can result in graft failure due to restricted coronary flow. The prevalence of stenosis of the left subclavian artery in patients with severe coronary atherosclerosis, deemed candidates to CABG, is not known. Objective: To assess the prevalence of stenosis of left subclavian artery in CABG candidates, as well as the diagnostic effectiveness of clinical evaluation. Methods: In a multicenter registry, selective angiography of the left subclavian artery was carried out in patients considered candidates to CABG during coronary cineangiography. Stenoses ≥ 50% proximal to the origin of the LITA were considered significant. Results: A total of 205 patients were included. Significant stenosis of the left subclavian artery was observed in 16 (7.8%) patients. Noninvasive differential arterial blood pressure measurement ≥ 10 mmHg between both arms showed low sensitivity (37.5%) and low positive predictive value (13.3%) for stenosis identification. No clinical predictors of significant stenosis were identified by univariate analysis. Conclusion: Stenosis of the left subclavian artery is not uncommon in CABG candidates. Noninvasive blood pressure gradient between both arms has low diagnostic accuracy. Therefore, in patients candidates to CABG, selective angiography of the left subclavian artery should be considered, because of the risk of reduced flow and coronary-subclavian steal syndrome in patients with non-diagnosed stenosis of the subclavian artery who receive a LITA graft.

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Midterm Results of Free Internal Thoracic Artery Grafting for Myocardial Revascularization

Cited by 9 publications

References 11 publications

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

Multi‐arterial and total‐arterial coronary revascularization: Past, present, and future perspective

Diagnosis and Management of Subclavian Artery Stenosis Prior to Coronary Artery Bypass Grafting in the Current Era

Prevalência de estenose da artéria subclávia em pacientes candidatos a cirurgia de revascularização do miocárdio: registro multicêntrico

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