Myocardial Revascularization with Multiple Arterial Grafts

Abstract

Froiii October 1991 td Jiily 1994, 439 patients iiiidenverit elective or iirgent coroitary artery bypass graftiiig irtiliziiig 2 or more arterial conduits. Age ranged froiii 28 to 79 years (iiieaii, 62.3 years). Most of the patients had 3-vessel disease (301); the reiminiiig ha~2-vessel(120) or 1 -vessel (18) disease. A steriosis of the left itiaiii triirtk greater tliari or eqiral to 50% was present in 73 patients; in 16 cases it ions a redo operation. The left veiitriciilar ejection fraction ranged front 0.19 to 0.84 (nieaii, 0.53). We utilized I 1 10 arterial coiidirits (430 left iiiteriial iiiaiiiiiiory arteries, 259 right iiitenial iiianiiiiary arteries, I36 riglit gastroepiploic arteries, I20 iiferior epigastric arteries, I65 radial arteries) together with I13 sapheiioiis veins (2.63 arterial aiiastoiiioses per patient, raiigiiig froiii 2 to 6). In 347pntients (79%) we perforiiiecl a coiiiplete arterial niyocardid revasciilarizatioii ivitli aii average of 2.80 aiiastoiiioses per patient. Two arterial coiidirits were used in 245 patients, 3 in 163, 4 iii 30, aid 5 in I patient. The inyocardial protectioii ivas achieved by iiieaiis of interinittent aiitegrade warm blood cardioplegia. The iiieaii cross-claiiiping time I V~S 47.3 f 16 iiiiiiiites (range, 16 to 142 iiiiiiiites). Five patients (1.1 %fdied iii the postoperative period, none were in the operating theater. The caiises of death were cardiac (2), sepsis ( I ) , pneiiiiioiiia ( I ) and poiicreatic necrosis ( I ) . I n 7 patieiits (1.6%) a perioperative inyocardial necrosis occirrred witlioirt any heiiiodyiiariiic seqiielae. Out of 430 patients alive, 41 9 (97.4%) are asyiiiptoniatic. At the postoperative aiigiograpliic coiitrol all the arterial grafts explored showed coiiiplete pateiicy; the iiiidteriii aiigiograpliy (iiieari, 14 iiioiitlis) revealed a cumiilative pateiicy of 96% (range, 100% for the left iriteriial tlioracic artery to 94.1% for the radial artery). We coricliide that oii the basis of the early resiilts the techriiqire liereiri described is effective arid reproducible, eveii i f long-term follow-iip is peeded to coiifiriir these data.

Variations in the branching pattern in inferior mesenteric artery: a series of five cases

“…Inferior mesenteric artery and its branches have been used as graft and as an alternative to the internal thoracic artery in coronary revascularization due to less atherosclerotic involvement and higher success rates (VAN TONDER, BOON, BECKER et al, 2007;CALAFIORE, DI GIAMMARCO, TEODORI et al, 1995;MIKKELSEN, 1995).…”

Rare left colic artery variation of the gut arterial system

“…Additionally, the described vasculature could complicate procedures including pancreatectomy, pancreaticoduodenectomy, cholecystectomy, colectomy and hepatectomy (Nayak, Shetty et al 2013). Arteries supplying the abdominal viscera have also been investigated regarding their efficacy in bypass procedures, so an understanding of gut arterial anastomoses is necessary to determine if such a procedure is possible (Calafiore, Giammarco et al 1995).…”