We report a new strategy of total arterial revascularization based on bilateral internal thoracic arteries (ITAs) and a radial artery (RA). The technique employs a graft extension of the proximal third of the right in...
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We report a new strategy of total arterial revascularization based on bilateral internal thoracic arteries (ITAs) and a radial artery (RA). The technique employs a graft extension of the proximal third of the right internal thoracic artery (RITA) with the RA, in combination with the T-graft technique, by which the lower two-thirds of the free RITA is anastomosed to the side of the left internal thoracic artery (LITA). (Ann Thorac Surg 1999;67:1186-7) (C) 1999 by The Society of Thoracic Surgeons.
Background. Postoperative blood loss, respiratory distress, and pain after coronary artery operation were assessed in a prospective, randomized, clinical study comparing two techniques of internal thoracic artery prep...
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Background. Postoperative blood loss, respiratory distress, and pain after coronary artery operation were assessed in a prospective, randomized, clinical study comparing two techniques of internal thoracic artery preparation. Methods. In group A (n = 57) the internal thoracic artery was dissected with the entire surrounding connective tissue after opening the pleura, using routine lateral pleural drainage. In group B (n = 55) a venoarterial pedicle was prepared without surrounding muscle leaving the pleura intact. We assessed blood loss, clinical outcome, lung function, location, intensity, and quality of pain 6 days and 3 months after the operation. Results. Significantly higher blood loss was observed in group A (A, 608 +/- 58 mL;B, 470 +/- 48 mL;p = 0.027). Forced expiratory volume in 1 second was significantly decreased in group A 6 days after surgery (A, 76.0% +/- 1.6%;B, 83.2% +/- 1.6%;p = 0.020). The forced expiratory volume in 1 second correlated to inspiratory vital capacity, which confirmed the advantage of the venoarterial technique (A, 0.771 +/- 0.021;B, 0.832 +/- 0.020;p = 0.003). Vital capacity was significantly higher in the venoarterial group at 3 months (A, 85.2% +/- 2.1%;B, 98.5% +/- 1.2%;p = 0.009), but not on postoperative day 6. The incidence of pleural effusion and atelectasis was significantly higher in group A (effusion: A, 52.6%;B, 23.6%;p = 0.002;atelectasis: A, 42.1%;B, 20.0%, p = 0.015). Sternal pain (A, 36.8%;B, 9.1%;p = 0.001) and suspenders pain (A, 33.3%;B, 7.3%;p = 0.001) occurred more often in group A. When using a multidimensional pain score, patients in group A experienced significantly sharper (6 days: A, 6.7 +/- 0.3;B, 3.3 +/- 0.2;p = 0.018;3 months: A, 3.5 +/- 0.3;B, 1.4 +/- 0.3;p = 0.046) and more annoying pain (6 days: A, 7.6 +/- 0.2;B, 2.7 +/- 0.1;p = 0.036;3 months: A, 6.6 +/- 0.3;B, 2.3 +/- 0.2;p = 0.040). Conclusions. These results demonstrate that the venoarterial preparation technique is superior to conventional interna
Background. Clinical studies have demonstrated a significant reduction of cardiac index shortly after transmyocardial laser revascularization in patients with low ejection fraction. We analyzed the influence of transm...
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Background. Clinical studies have demonstrated a significant reduction of cardiac index shortly after transmyocardial laser revascularization in patients with low ejection fraction. We analyzed the influence of transmyocardial laser revascularization on healthy myocardium in pigs. Methods. Carbon dioxide channels were created in 20 pigs which were observed for 6 hours. Ten pigs received one laser channel and ten pigs two laser channels per cm(2) in the left anterior descending artery region. Seven pigs served as controls. Perfusion (microspheres), function, histochemical, and histologic assessments were subsequently performed. Results. A significant deterioration of left ventricular stroke work index was observed shortly after transmyocardial laser revascularization in both laser groups (p < 0.05). After 6 hours the left ventricular stroke work index did not increase and showed significantly reduced values at rest (p < 0.05) and during stress in the laser groups (p < 0.01). Normal regional perfusion, small ischemic and necrotic areas, open laser channels in the left anterior descending artery region and significantly increased myocardial water content were observed in the laser groups (p < 0.01). Conclusions. Carbon dioxide laser channels significantly decrease global heart function shortly after transmyocardial laser revascularization in healthy porcine myocardium. This myocardial tissue showed no recovery 6 hours postoperatively. (C) 1999 by The Society of Thoracic Surgeons.
Surgical coronary revascularization, especially in geriatric patients, is technically demanding and requires careful patient selection, selection of type of procedure, and postoperative care. Recent advances in corona...
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