The internal mammary artery graft for ischemic heart disease. Effect of revascularization on survival

Loop, Floyd D.; Irarrázaval, Manuel J.; Bredée, Johan J.; Siegel, Wayne; Taylor, Paul C.; Sheldon, William C.

doi:10.1016/0002-9149(76)90657-3

Cited by 8 publications

(11 citation statements)

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“…In contrast, the LITA has proved to have better patency with excellent clinical results [3,6]. Based on the clinical advantages of the LITA, there was, over the last decade, a reappearance of the use of other arterial grafts as an option to improve the long-term results of surgery [7,8,[14][15][16][17].…”

Section: -Estimated Probability Free From Re-interventionmentioning

confidence: 99%

“…Since the start of the 1970s, when many publications [3,6] confirmed the benefits of the use of the internal thoracic artery (better survival, reduced operative morbidity, lower rate of peri-operative infarction, and greater patency of the LITA), this graft became practically obligatory in all CABGs. In another publication in 1994, the Cleveland Clinic reported the results of the long-term follow up (18 to 20 years) of patients that received the LITA compared to those that received saphenous vein bypasses to revascularize the anterior descending artery, with and without additional grafts for the revascularization of the right coronary artery or branches of the circumflex artery.…”

Section: -Estimated Probability Free From Re-interventionmentioning

confidence: 99%

“…The saphenous vein was always the most commonly used graft for CABG [1,2], but at the end of the 1970s the left internal thoracic artery (LITA) graft started to be utilized more frequently [3]. Since then, myocardial revascularization surgery utilizing a combination of the LITA with saphenous vein bypasses became the standard procedure in the treatment of coronary artery disease; a conduct that persists until today in the majority of heart surgery centers.…”

Section: Introductionmentioning

confidence: 99%

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Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriais

Abdouni¹,

Lisboa²,

Puig³

et al. 2008

Rev Bras Cir Cardiovasc

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Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriaisLong-term follow-up of patients undergone coronary artery bypass grafting with exclusive use of arterial grafts Abstract Objective: To evaluate the long-term results of coronary artery bypass grafting with the exclusive use of arterial grafts for patients with triple vessel disease.Methods: We evaluated 136 patients who underwent isolated coronary artery bypass grafting between January 1995 and December 1997. A total of 353 grafts were used for revascularization of 449 arteries (mean: 3.30 per patient). Grafts used were the left internal thoracic artery (99.2%), right internal thoracic artery (56.6%), radial artery (87.5%), right gastroepiploic artery (20.5%) and one inferior epigastric artery. Seventy-six (55.8%) patients received composite grafts ("Y-shape") and 66 (48.5%) patients received sequential anastomoses.Results: Hospital mortality was 4.4%. In the long-term follow-up (9.5 to 12.8 years), 82.1% of the patients were free of cardiac events. Twenty (17.9%) patients had hospital readmission due to cardiac events: 15 presented angina and five presented acute myocardial infarction, with three of them presenting with associated heart failure. Eight (7.1%) patients needed coronary re-interventions: one underwent coronary bypass reoperation and the others underwent coronary angioplasty with stent implantation. Estimated probability of being event-free was 98.2%, 95.4% and 84.2% at 1, 5 and 10 years of follow-up respectively. There were 16 (14.2%) late deaths with four of them (3.6%) being cardiacrelated. Actuarial 12.8-year survival of all types of death was 85% in this group.Conclusion: Coronary artery bypass grafting with the exclusive use of arterial grafts is a safe procedure for patients with triple vessel coronary disease with good long-term results.Descriptors: Myocardial revascularization. Arteriosclerosis/ surgery. Mammary arteries. Radial artery. ResumoObjetivo: Avaliar os resultados a longo prazo da cirurgia de revascularização do miocárdio com o uso exclusivo de enxertos arteriais em pacientes com doença coronariana triarterial.

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Section: -Estimated Probability Free From Re-interventionmentioning

confidence: 99%

Section: -Estimated Probability Free From Re-interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriais

Abdouni¹,

Lisboa²,

Puig³

et al. 2008

Rev Bras Cir Cardiovasc

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“…Entretanto, muitos trabalhos tentam demonstrar que a utilização de dupla mamária representa uma melhora em comparação com os resultados da mamária simples, embora isto não esteja bem comprovado. Existe também um forte sentimento de que a revascularização arterial completa seja melhor que a revascularização com ATIE e veia safena [47][48][49][50][51][52][53][54][55][56] .…”

Section: Seleção Dos Condutosunclassified

Diretrizes da cirúrgia de revascularização miocárdica valvopatias e doenças da aorta

Lima¹,

Kubrusly²,

A³

et al. 2004

Arq. Bras. Cardiol.

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Arq Bras Cardiol volume 82, (suplemento V), 2004 Diretrizes da Cirúrgia de Revascularização Miocárdica 3 Avaliação Pré-OperatóriaOs objetivos do tratamento cirúrgico da insuficiência coronariana são aliviar sintomas, proteger o miocárdio isquêmico, melhorar a função ventricular, prevenir o infarto do miocárdio, recuperar o paciente físico, psíquica e socialmente, prolongar a vida e a sua qualidade.A avaliação pré-operatória é importante e tem como finalidade minimizar os riscos cirúrgicos e, também, prevenir as complicações pós-operatórias.A decisão de postergar a cirurgia com objetivo de tratar uma co-morbidade é uma decisão difícil e que deve ser bem avaliada. A decisão deve focar ambas as condições, a indicação primária (cardíaca) e a co-morbidade. A severidade da angina e a da dispnéia devem ser quantificadas, de acordo com os critérios da Canadian Cardiovascular Society (CCS) e New York Heart Association (NYHA) 8,9 . Avaliação clínicaA avaliação clínica compreende história clínica; exame físico e exames laboratoriais.História clínica -a) determinação dos fatores de risco: história de fumo, história familiar de doença arterial coronariana, diabetes, obesidade mórbida, dislipidemia, insuficiência renal, hipertensão arterial sistêmica, hipertensão pulmonar, história de acidente vascular cerebral, doença obstrutiva pulmonar, doença vascular periférica, doença vascular cerebral, características demográficas-idade e sexo; b) intervenção cardiovascular prévia: endoarterectomia de carótida, outra cirurgia vascular e procedimentos não cirúrgicos-angioplastia, aterectomia, laser, stent, trombólise e valvoplastia com balão; c) história: insuficiência cardíaca congestiva, infarto do miocárdio, ressuscitação cardíaca, tipo de angina, choque cardiogênico, arritmias-ventriculares, bloqueio AV, fibrilação atrial, aguda ou crônica; d) avaliação da dor torácica e de "equivalentes isquêmicos", como dispnéia ao esforço físico, ou dor no braço com esforço físico; e) critérios da Canadian Cardiovascular Society (CCS) 10 : classe 0: sem angina; classe I: angina aos grandes esforços; classe II: leve limitação às atividades de rotina; classe III: limitação importante das atividades físicas; classe IV: sem condições de realizar qualquer atividade física, angina em repouso.Exame físico -a) pressão arterial: medição nos dois braços. Quando apresentam diferença de pressão entre o direito e o esquerdo, com este menor que aquele, < 15 a 20mm/hg, deve se dar atenção para o paciente cirúrgico no momento do empre go do enxerto de ATIE, pois esta alteração pode causar, no pós-operatório, a chamada "síndrome do roubo". Portanto, é importante, nesta avaliação, afastar estenose de artéria subclávia esquerda ou pensar na presença de aneurisma dessecante de aorta; b) palpação dos pulsos periféricos e carotí-deos: importante para se programar cirurgia combinada ou tratar a lesão arterial em questão antes da revascularização miocárdica; c) ausculta cardíaca: deve-se também avaliar de maneira atenta a ausculta do precórdio, para confirmar ou não a...

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“…First, progressive atheroscle rosis was shown to be the single most impor tant cause of occlusion of aortocoronary sa phenous vein grafts between 5 and 10 years after bypass surgery [1][2][3][4][5][6][7][8]. On the other hand, it was reported that internal mammary artery grafts almost always remained free of athero sclerosis late after bypass surgery [9][10][11][12][13][14][15], Therefore, the internal mammary artery anastomosis to a coronary artery is now per formed in as many as 80-90% of patients in major surgical centers [16]. Nonetheless, op timal myocardial revascularization in pa tients with severe coronary' artery disease fre quently requires, in addition to internal mammary artery grafts, the use of one or sev eral aortocoronary saphenous vein grafts and late atherosclerosis in these grafts remains an important problem.…”

Section: Introductionmentioning

confidence: 99%

Atherosclerosis after Coronary Artery Bypass Surgery: Results of Recent Studies and Recommendations Regarding Prevention

Bourassa¹,

Campeau²,

Lespérance³

et al. 1986

Cardiology

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Atherosclerosis is the most frequent cause of occlusion of aortocoronary saphenousvein grafts between 5 and 10 years after coronary artery bypass surgery. The typical atherosclerotic plaque appears between 1 and 3 years after operation and, at a mean of 5 years, histologic changes of atherosclerosis are present in 21 % of grafts and in 27% of patients. Only approximately 60% of saphenous vein grafts remain patent at repeat angiography between 10 and 12 years after bypass surgery; 45% of patent grafts show atherosclerotic changes at angiography and 43% of patients show evidence of atherosclerosis in one or more saphenous vein grafts. We do not know whether the development or the progression of these atherosclerotic changes can be modified; however, the data currently available suggest that the administration of platelet inhibitors and/or of lipid lowering agents offer two promising avenues of investigation in patients undergoing aortocoronary saphenous vein bypass surgery. Until this has been carefully studied, the internal mammary artery should remain the preferred conduit for aortocoronary bypass grafting, whenever possible.

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The internal mammary artery graft for ischemic heart disease. Effect of revascularization on survival

Cited by 8 publications

References 0 publications

Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriais

Seguimento a longo prazo de pacientes submetidos à revascularização do miocárdio com uso exclusivo de enxertos arteriais

Diretrizes da cirúrgia de revascularização miocárdica valvopatias e doenças da aorta

Atherosclerosis after Coronary Artery Bypass Surgery: Results of Recent Studies and Recommendations Regarding Prevention

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