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PLACEMENT OF CORONARY-ARTERY BYPASS GRAFT WITHOUT PUMP OXYGENATOR

ANNALS OF THORACIC SURGERY 1975年第1期19卷 1-9页

作者： TRAPP, WG BISARYA, R UNIV BRITISH COLUMBIA FAC MEDDEPT SURGVANCOUVER V5Z IH3BRITISH COLUMBICANADA UNIV BRITISH COLUMBIA VANCOUVER GEN HOSPHYPERBARIC RES UNITVANCOUVER V5Z IH3BRITISH COLUMBICANADA

Patients undergoing open-heart operations are subject to morbidity related to the use of extracorporeal circulation. Peripheral experience gained from its use can be brought together to enable some of the operations to be performed without subjecting the patient to cardiopulmonary *** coronary and left anterior descending coronary artery grafting with vein or internal mammary artery can be done on the beating, functioning heart by stabilizing the distal anastomotic site with transfixion sutures and by perfusing the obstructed coronary artery from its own aorta through a cannula which also acts as a stent at the site of anastomosis. High oxygenation levels offer protection to the manipulated heart, and the use of heparin appears to ensure patency of the graft at operation.A series of 63 patients is reported in which there was no mortality related to the cardiac operation and only 1 death related to a presumed cerebrovascular accident. Cardiopulmonary bypass support was not required in any patient selected for this technique.

关键词：麻醉吸入/方法导管插入术/方法冠状动脉分流术/方法冠状动脉分流术/死亡率评价研究乳房动脉/外科学心肌血管重建术/方法心肌血管重建术/死亡率氧合器灌流/方法手术后医护麻醉前用药隐静脉缝合技术胸部动脉/外科学移植自体静脉/移植人类

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ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina - A report of the American College of Cardiology American Heart Association Task Force on Practice Guidelines

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第7期33卷 2092-2190页

作者： Gibbons, RJ Chatterjee, K Daley, J Douglas, JS Fihn, SD Gardin, JM Grunwald, MA Levy, D Lytle, BW O'Rourke, RA Schafer, WP Williams, SV

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Reoperative "off-pump" circumflex revascularization via left thoracotomy: How to prevent graft kinking

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ANNALS OF THORACIC SURGERY 2000年第1期70卷 309-310页

作者： Ricci, M Karamanoukian, HL D'Ancona, G Salerno, TA Bergsland, J Buffalo Gen Hosp Div Cardiothorac Surg Buffalo NY 14203 USA Kaleida Hlth Syst Div Cardiothorac Surg Buffalo NY USA Kaleida Hlth Syst Ctr Minimally Invas Cardiac Surg Buffalo NY USA

Reoperative circumflex revascularization can be performed through a left thoracotomy approach, with or without cardiopulmonary bypass. In such cases, establishing the appropriate length of coronary grafts connecting the descending thoracic aorta to one of the marginal branches of the circumflex coronary artery may be problematic. In fact, if these grafts are too long they may kink, whereas if left too short they may be injured by respiratory excursions of the left lower lobe of the lung. In this report we describe a technique that can prevent these potential complications. (Ann Thorac Surg 2000;70:309-10) (C) 2000 by The Society of Thoracic Surgeons.

关键词：心肌血管重建术/方法手术后并发症/预防和控制再手术胸廓切开术/方法人类

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Off-pump revascularization of the circumflex artery: Technical aspect and short-term results

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ANNALS OF THORACIC SURGERY 1999年第1期68卷 94-99页

作者： Cartier, R Blain, R Montreal Heart Inst Res Ctr Dept Surg Montreal PQ H1T 1C8 Canada Montreal Heart Inst Dept Anesthesia Montreal PQ H1T 1C8 Canada

Background. Beating heart surgery is a technique currently used for revascularization of the anterior and inferior territory. However, revascularization of the circumflex artery is more problematic. With a specific apparatus and surgical technique, we have extended the use of beating heart surgery to more than 90% of patients with multivessel disease, including those necessitating circumflex artery revascularization. Methods. Between October 1996 and November 1997, 140 patients underwent beating heart surgery by the same surgeon (R.C.). Among these patients, 111 required reconstruction of the circumflex artery territory and were followed up prospectively. They represent the cohort of patients presented in this study. There were 90 men and 21 women averaging 64 +/- 9.9 years of age. Mean left ventricular ejection fraction was 55% +/- 13.7%, and a significant left main coronary artery disease was present in 27% of the patients. Five patients had prior coronary revascularization. Results. An average of 3.1 +/- 0.1 grafts/patient were performed. Complete revascularization was achieved in 95%. Only 1 patient needed conversion to cardiopulmonary bypass because of spontaneous ascending aortic dissection. Perioperative and postoperative bleeding were 446 +/- 245 mL and 644 +/- 442 mL, respectively. Homologous transfusions were required in 40% of the patients. Myocardial infarction occurred in 2.7% and operative mortality in 0.7% (1 patient). Average hospital stay was 6.6 +/- 3.1 days, and no patient exhibited early recurrence of angina. Early coronary angiograms (first 8 patients) demonstrated a 100% patency with 95% freedom from significant stenosis. Conclusions. Complete coronary artery revascularization is feasible on the beating heart without the assistance of cardiopulmonary bypass with a low morbidity and mortality and excellent early angiographic results. Long-term follow-ups are needed to substantiate the potential long-term benefits of this technique. (C) 1999 by T

关键词：心肺转流术心肌血管重建术/仪器和设备心肌血管重建术/方法危险因素外科器械血管未闭成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Stents covered by autologous venous grafts: Feasibility and immediate and long-term results

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AMERICAN HEART JOURNAL 2000年第3期139卷 437-445页

作者： Stefanadis, C Toutouzas, K Tsiamis, E Vlachopoulos, C Kallikazaros, I Stratos, C Vavuranakis, M Toutouzas, P Univ Athens Hippokrat Hosp Dept Cardiol GR-10679 Athens Greece

Background Previous experimental studies with a new covered stent, the autologous venous graft-covered stent (AVGCS), have shown favorable results. The aim of this study was to evaluate the feasibility and safety of this new technique in human coronary arteries and to compare the long-term outcome with uncovered stents. Methods and Results A venous graft was removed from an upper limb. A conventional stent then was covered by the venous graft. Fifty-eight AVGCS were implanted in 56 patients, including 16 patients with acute coronary syndromes (ACS). Additionally, in 114 patients, 138 uncovered stents were implanted, serving as a control group, including 38 patients with ACS, The procedure was successful in all patients. Stent thrombosis was observed in 3 patients in the control group and in 1 patient with an AVGCS. There was a trend for the minimal luminal diameter to be greater in the AVGCS group at follow-up (P = .07), and statistical significance was observed in patients with ACS (P < .01). The target vessel revascularization and the restenosis rates were similar between the 2 groups. In patients with ACS, the restenosis rate was less (P < .04) and there was a trend for target vessel revascularization to be less in covered stents (P = .09). The event-free survival rate at 4 years was 85% in the AVGCS group versus 81% in the control group (P = not significant);in ACS it was 94% versus 78%, respectively (P = not significant). Stents covered by thicker venous grafts were associated with improved clinical outcome. Conclusions stents covered by autologous venous grafts may be safely prepared without complications. This technique may prove to be a useful means, especially in patients with ACS.

关键词：冠状血管造影术冠心病/外科学冠状血管/外科学无病生存可行性研究随访研究移植物闭塞血管/诊断移植物闭塞血管/流行病学心肌血管重建术/方法危险性评估支架血栓形成/诊断血栓形成/流行病学移植自体治疗结果静脉/移植女(雌)性人类男(雄)性中年人

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Cost estimates for treatment of cardiac ischemia (from the Asymptomatic Cardiac Ischemia Pilot [ACIP] study)

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第11期84卷 1311-1316页

作者： Pepine, CJ Mark, DB Bourassa, MG Chaitman, BR Davies, RF Knatterud, GL Forman, S Pratt, CM Sopko, G Conti, CR Univ Florida Coll Med Div Cardiovasc Med Gainesville FL USA Duke Univ Sch Med Durham NC USA Montreal Heart Inst Res Ctr Montreal PQ H1T 1C8 Canada St Louis Univ Med Ctr St Louis MO USA Univ Ottawa Inst Heart Res Ctr Ottawa ON Canada Maryland Med Res Inst Baltimore MD USA Baylor Coll Med Houston TX 77030 USA NHLBI Bethesda MD 20892 USA

Costs for management of myocardial ischemia are enormous, yet comparison cost and outcome data for various ischemia treatment strategies from randomized trials are lacking and will require cost and resource utilization data fram a large prospective trial. The Asymptomatic Cardiac Ischemia Pilot provided feasibility data for planning such a trial and on opportunity to estimate the long-term costs of different treatment strategies. Economic implications for ischemia management were compared in 558 patients with stable coronary artery disease and myocardial ischemia during both stress testing and daily life. Participants were randomized to 3 different initial treatment strategies and followed for 2 years. Based on cost trends over follow-up, costs for subsequent care were estimated. As expected, due to initial procedural costs, at 3 months, estimated costs for revascularization were approximately 10 times greater than costs for a medical care strategy. Extrapolated costs for anticipated resource consumption for care beyond 2 years, however, were approximately 2 times greater for an initial medical care strategy than for initial revascularization. This was due to increased need for drugs and hospitalizations for bath late revascularizations and other ischemia-related events. Estimated costs for anticipated care in the medical strategies reached the anticipated cost of the revascularization strategy within 10 years. Because this cost-equal time period is well within the median life expectancy for such a patient population, these findings could have important public health implications and require testing in a full-scale prognosis trial. We anticipate that over the patients' life expectancy, early revascularization is likely to become either cost-neutral or cost-effective. (C) 1999 by Excerpta Medica, Inc.

关键词：血管成形术经腔经皮冠状动脉/经济学冠状动脉分流术/经济学成本及成本分析可行性研究卫生保健费用心肌缺血/经济学心肌缺血/死亡率心肌缺血/治疗心肌血管重建术/经济学心肌血管重建术/方法试点项目前瞻性研究存活率治疗结果女(雌)性人类男(雄)性中年人

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The PRESTO (Prevention of Restenosis with Tranilast and its Outcomes) protocol:: A double-blind, placebo-controlled trial

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AMERICAN HEART JOURNAL 2000年第1期139卷 23-31页

作者： Holmes, D Fitzgerald, P Goldberg, S LaBlanche, JM Lincoff, AM Savage, M Serruys, PW Willerson, J Granett, JR Chan, R Shusterman, NH Poland, M Mayo Clin & Mayo Fdn Div Internal Med & Cardiovasc Dis Rochester MN 55905 USA Stanford Univ Stanford CA 94305 USA Cooper Hosp Univ Med Ctr Camden NJ 08103 USA Hosp Cardiol Lille France Cleveland Clin Fdn Cleveland OH 44195 USA Thomas Jefferson Univ Hosp Philadelphia PA 19107 USA Ctr Heart Rotterdam Netherlands Univ Texas Sch Med Houston TX USA Texas Heart Inst Houston TX 77025 USA SmithKline Beecham Collegeville PA 19426 USA

Background Tranilast is a unique drug in clinical development for the prevention of restenosis after percutaneous transluminal coronary revascularization (PTCR). Tranilast interferes with proliferation and migration of vascular medial smooth muscle cells induced by platelet-derived growth factor and transforming growth factor beta 1. Collagen synthesis in vascular medial smooth muscle cells is inhibited by tranilast, which also inhibits the release or production of cyclooxygenase-2 and restores cytokine-induced nitric oxide production. These mechanisms may contribute to the reduction of angiographic restenosis after coronary intervention previously reported in clinical studies. Methods The primary objective of this multicenter study of 11,500 patients is to compare the composite clinical event rate of death, myocardial infarction, or the need for ischemia-driven target vessel revascularization of tranilast (300 and 450 mg twice daily) for I or 3 months with that of placebo in patients undergoing PTCR with or without stenting for single or multiple vessels over a 9-month period. The lesions can be de novo or restenotic. All revascularization procedures and the use of glycoprotein IIb/IIIa agents are permitted. The inclusion criteria are meant to allow an "all comer" approach for generalization of results to the broadest possible PTCR population. A subset population (n = 2000) will undergo 9-month follow-up angiography, 1000 of which will also undergo intravascular ultrasound (n = 1000). This study is the first tranilast trial to be conducted in a Western population to confirm the improved angiographic findings reported in Japanese patients and to determine if the clinical sequelae of restenosis are also reduced. Conclusion This multicenter study is the largest restenosis trial planned to date. It will test whether tranilast, a drug with multiple actions aimed at affecting proliferation and migration of vascular smooth muscle cells, can reduce clinical, angiographic,

关键词：邻氨基苯甲酸类/药代动力学邻氨基苯甲酸类/治疗应用冠状血管造影术冠心病/放射摄影术冠心病/治疗冠心病/超声检查双盲法移植物闭塞血管/血液移植物闭塞血管/诊断移植物闭塞血管/死亡率移植物闭塞血管/预防和控制心肌血管重建术/方法血小板聚集抑制剂/药代动力学血小板聚集抑制剂/治疗应用复发/预防和控制安全存活率治疗结果超声检查介入性美国/流行病学青少年人类

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Viability of Q-wave infarcted myocardium with restored positive and persistent negative T waves after optimal revascularization compared with dobutamine stress echocardiography

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期85卷 31-36页

作者： Watanabe, S Kawamura, Y Watanabe, Y Tanaka, K Tanaka, K Takei, Y Ejiri, N Shimada, K Hitachi Gen Hosp Dept Cardiol Hitachi Ibaraki Japan Jichi Med Sch Dept Cardiol Minami Kawachi Tochigi 32904 Japan

To clarify the clinical difference in viability of myocardium with negative and positive T waves in Q-wave anterior or anteroseptal myocardial infarction, we performed low-dose dobutamine stress echocardiography in 17 patients with negative T waves and in 13 patients with positive T waves with optimal revascularization of infarct-related arteries in the chronic phase of infarction. At baseline the wall motion score (WMS) of the negative and positive T groups was 25.8 +/- 3.0 and 22.3 +/- 2.2 points (p < 0.05), respectively. At peak stress WMS in each group was 27.2 +/- 4.2 and 19.8 +/- 2.4 points (p < 0.0001), respectively. With dobutamine stress WMS in the positive T group was more decreased than that of the negative T group (p < 0.0001). We conclude that the restored positive T waves in Q-wave myocardial infarction indicate a significantly greater amount of viable myocardium than the negative T waves, showing better regional wall motion improvement with low-dose dobutamine stress. (C) 2000 by Excerpta Medica, Inc.

关键词：强心药/诊断应用冠状血管造影术肌酸激酶/血液多巴酚丁胺/诊断应用超声心动描记术/方法心电描记术/方法运动试验/方法随访研究心肌梗死/诊断心肌梗死/酶学心肌梗死/病理生理学心肌梗死/治疗心肌血管重建术/方法预后敏感性与特异性疾病严重程度指数老年人女(雌)性人类男(雄)性中年人

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Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期34卷 1663-1670页

作者： Lauer, B Junghans, U Stahl, F Kluge, R Oesterle, SN Schuler, G Univ Leipzig Herzzentrum Gmbh Klin Innere Med Kardiol D-04289 Leipzig Germany Univ Leipzig Klin Nukl Med D-04289 Leipzig Germany Stanford Med Ctr Dept Cardiol Stanford CA USA

OBJECTIVES This study evaluates the feasibility, and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris. BACKGROUND In patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality. METHODS A catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions. Thirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III-IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one Vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clin

关键词：心绞痛/外科学冠状血管造影术冠心病/外科学可行性研究激光疗法/方法心肌血管重建术/方法试点项目治疗结果老年人老年人 80以上女(雌)性人类男(雄)性中年人

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DIRECT SELECTIVE MYOCARDIAL REVASCULARIZATION BY INTERNAL MAMMARY ARTERY CORONARY VEIN ANASTOMOSIS

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JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1975年第1期69卷 63-72页

作者： PARK, SB MAGOVERN, GJ LIEBLER, GA DIXON, CM BEGG, FR FISHER, DL DOSIOS, TJ GARDNER, RS ALLEGHENEY GEN HOSP DIV SURG RESPITTSBURGHPA 15212 ALLEGHENY GEN HOSP DIV THORAC & CARDIOVASC SURGPITTSBURGHPA 15212 ALLEGHENY GEN HOSP DIV CARDIOLPITTSBURGHPA 15212

In this report, we shall describe our work with retrograde coronary perfusion, first in mongrel dogs and then in 6 patients. The left internal mammary artery (LIMA) is anastomosed to the left anterior descending coronary vein (LADV) to provide myocardial perfusion. This procedure may he of great value in the treatment of patients who are not suitable candidates for direct coronary bypass grafting, i.e., those who have diffuse atherosclerosis, with poor or no runoff of the left anterior descending coronary artery (LADA), but who have satisfactory left ventricular contraction.

关键词：心血管造影术心肺转流术冠状动脉分流术冠心病/诊断冠心病/死亡率冠心病/外科学冠状血管/外科学随访研究乳房动脉/外科学心肌梗死/病理学心肌梗死/外科学心肌血管重建术/方法心肌/病理学氧耗量灌流放射性核素显像隐静脉/移植血清白蛋白放射性碘标记胸部动脉/外科学移植自体静脉/外科学成年人动物狗人类男(雄)性中年人

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