Total arterial revascularization: A superior method of cardiac revascularization
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Abstract:
For over 40 years, the left internal thoracic artery has been used as the gold standard for myocardial revascularization and anastomosis over the left anterior descending artery due to its excellent patency rates. However, the right internal thoracic artery behaves in the same manner as the left, also having excellent long-term patency. Hence, no patient should be deprived of the benefits of total arterial revascularization allowed by the bilateral use of both internal thoracic arteries.Keywords:
Internal thoracic artery
Myocardial Revascularization
Gold standard (test)
Objective:To inquire and expound the newest development of revascularization treatment in coronary heart disease.Method:Reading the literature about revascularization and then summarizing them.Result:Clinical study and experimental study making clear that revascularization is a complicated process,its mechanism concluding a lot of fields.It effects a good care to myocardial ischemia.Conclusion:Therapeutic angiogenesis will be a new way to clinical coronary heart disease. [
Myocardial Revascularization
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Identifying viable myocardium with FDG-PET imaging identified patients with left ventricular (LV) dysfunction who benefited from revascularization and had improved survival. Contrast-enhanced magnetic resonance imaging also has been shown to identify viable myocardium. Baseline ejection fraction, magnitude of myocardial scarring, degree of LV remodeling, and time to revascularization are inversely related to functional recovery after revascularization.
Myocardial Revascularization
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Recent studies on the role of viable myocardium in revascularization are hot spots. The definition of viable myocardium, multimodality imaging in the assessment of myocardial viability, Meta analyses related to the value of viable myocardium in revascularization, prospective randomized trials, and factors affecting the prognosis of patients after revascularization are reviewed in this article.
Key words:
Myocardial ischemia; Myocardial stunning; Myocardial reperfusion; Trends
Myocardial Revascularization
Hibernating myocardium
Myocardial Stunning
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Before the advent of CABG, standardized in the late '60s by Favaloro and Effler, patients with myocardial ischemia underwent indirect and heterogeneous off-pump methods of myocardial revascularization.Indirect revascularization, such as periaortic nerve plexus interruption, Vineberg operation, Sen procedure and, less remotely, TMR Laser and stem cell transplantation, represented some of the ways to achieve myocardial revascularization. Nowadays, direct coronary revascularization is the only established technique and may be performed either on-pump or off-pump.The comparison of off-pump and on-pump myocardial revascularization paved the way to an endless debate between the advantages and disadvantages of each technique. In this article, we review the old and current off-pump approaches of surgical myocardial revascularization.
Myocardial Revascularization
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For over 40 years, the left internal thoracic artery has been used as the gold standard for myocardial revascularization and anastomosis over the left anterior descending artery due to its excellent patency rates. However, the right internal thoracic artery behaves in the same manner as the left, also having excellent long-term patency. Hence, no patient should be deprived of the benefits of total arterial revascularization allowed by the bilateral use of both internal thoracic arteries.
Internal thoracic artery
Myocardial Revascularization
Gold standard (test)
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Myocardial Revascularization
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Objectives: Despite encouraging late outcomes, the use of bilateral internal thoracic artery (BITA) grafting for myocardial revascularization in diabetic patients remains controversial because of an increased risk of sternal complications. In the present study, early and longterm outcomes of BITA- versus single internal thoracic artery (SITA)- grafting in young (< 65 years of age) diabetic patients were reviewed retrospectively.
Internal thoracic artery
Myocardial Revascularization
Cardiothoracic surgery
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MATERIAL AND METHODS Between August 2002 and September 2004, 276 patients with coronary artery disease underwent surgical treatment using a Y-shaped conduit formed from two internal thoracic arteries (ITA). In 268 (97.1%) patients, myocardial revascularization required exclusively bi-mammary bypass grafting. In creation of the Y-shaped conduit in the capacity of a free transplant, the intercepted right ITA was connected to the left internal thoracic artery (LITA). In the remaining 7 (2.5%) patients, venous bypasses together with the internal thoracic arteries were employed: in one patient (0.36%), the radial artery was used. RESULTS Three patients (1.08%) died after operation. The survival rate accounted for 98.4%. CONCLUSION The use of two internal thoracic arteries for complete myocardial revascularization provided beneficial results in the short- and long-term postoperative periods.
Internal thoracic artery
Mammary artery
Myocardial Revascularization
Electrical conduit
Coronary arteries
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Objective: Off-pump myocardial revascularization using bilateral mammary artery (BIMA) is a promising concept in cardiac surgery during the last years. Beside proven benefits toward off-pump surgery, there is an ongoing debate, whether single mammary artery revascularization (SIMA) is superior to the BIMA revascularization in the short and long term course.
Mammary artery
Myocardial Revascularization
Single Center
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A study of 100 consecutive patients requiring multiple coronary artery bypasses was undertaken to evaluate the feasibility of routine use of multiple internal mammary artery (IMA) anastomoses. In 99 patients the IMA was used and in 80 patients bilateral IMA bypasses were done. In 15 patients multiple anastomoses with a single IMA precluded the need for bilateral IMA bypasses. In only 4 patients were bilateral IMA left to be contraindicated. By combination of use of both IMAs, free grafts and sequential grafts, the IMA accounted for 70% of the 318 anastomoses in these 100 patients. Scrupulous attention to technique and the use of the operating microscope are necessary to achieve multiple IMA anastomoses. It was concluded that the IMA can be used to supply the majority of anastomoses needed for coronary artery revascularization in nearly all patients.
Mammary artery
Myocardial Revascularization
Surgical anastomosis
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