Register
Forgot your password?

Sequential coronary artery bypass grafting with both internal thoracic arteries on a beating heart

Authors: Zhelikhazheva M.V., Merzlyakov V.Yu., Baychurin R.K.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2018-12-2-183-190

For citation: Zhelikhazheva M.V., Merzlyakov V.Yu., Baychurin R.K. Sequential coronary artery bypass grafting with both internal thoracic arteries on a beating heart. Creative Cardiology. 2018; 12 (2): 183–90 (in Russ.). DOI: 10.24022/1997-3187-2018-12-2-183-190

Received / Accepted:  July 14, 2017 / August 11, 2017

Keywords: coronary artery bypass grafting sequential grafting bimammary coronary artery bypass grafting myocardial revascularization on a beating heart

Download
Full text:  

 

Abstract

Sequential bypass grafting is an effective method of myocardial revascularization in a number of situations where standard revascularization is not possible for a number of reasons (with atherosclerotically altered ascending aorta, hemodynamically significant lesions of the subclavian artery, deficiency of conduits, repeated operations of coronary artery bypass grafting, etc.). The subcutaneous vein is still widely used as an aortic/coronary artery shunt because of the ease of access, preparation and the possibility of use for multiple shunts. However, this type of shunt can develop intima hyperplasia and atherosclerotic lesions with an occlusion level of 10–15% in the first year after surgery. After 10 years, only 60% of venous shunts remain passable, of which only 50% have no signs of significant stenosis. There may also be complications in the lower limb where the fence occurred. The internal thoracic artery rarely develops atherosclerosis, and its diameter is usually comparable with the diameter of the coronary artery, which requires revascularization. In our case, the circumstances that led to the choice of the technique of sequential shunting were associated with a lack of conduits and the desire for more complete revascularization.

Acknowledgements. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.

References

  1.  Zen’kov A.A., Ostrovskiy Yu.P., Vykhristenko K.S., Leyko N.G. Comparative analysis of the results of minimally invasive myocardial revascularization, coronary bypass surgery on the working heart and with artificial circulation. News of Surgery. 2014; 22 (1): 33–43 (in Russ.).

  2. Zotov A.S., Anokhin A.V., Arinchev A.S., Tereshchenko V.I., Shin A.R., Tsvetkov D.S. The choice of a shunt in coronary surgery. Clinical Practice. 2015; 2: 35–45 (in Russ.)

  3. Taggart D.P. Current status of arterial grafts for coronary artery bypass grafting. Ann. Cardiothorac. Surg. 2013; 2: 427–30. DOI: 10.1186/isrctn46552265

  4. Tatoulis J. Total arterial coronary revascularization – patient selection, stenoses, conduits, tar- gets. Ann. Cardiothorac. Surg. 2013; 2: 499–506. DOI: 10.1093/mmcts/mmt017

  5.  Kovalenko O.A., Iraskhanov A.K. Modern trends in arterial revascularization of the myocardium. The Bulletin of Bakoulev Center for Cardiovascular Diseases. 2012; 13 (2): 18–26 (in Russ.).

  6. Buxton B.F., Ruengskulrach P., Fuller J. et al. The right internal thoracic artery graft – benefits of grafting the left coronary system and native vessels with a high-grade stenosis. Eur. J. Cardiothorac. Surg. 2000; 18: 255–61. DOI: 10.1016/s1010-7940(00)00527-3

  7. Buxton B.F., Tatoulis J., Fuller J.A. The right internal thoracic artery: the forgotten conduit – 5,766 patients and 991 angiograms. Ann. Cardiothorac. Surg. 2011; 92: 9–17. DOI: 10.1016/j.athoracsur.2011.03.099

  8. Lytle B.W., Blackstone E.H., Sabik J.F. et al. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann. Thorac. Surg. 2004; 78: 2005–12. DOI: 10.1016/j.athoracsur.2004.05.070

  9. Sabik J.F.I., Lytle B.W., Blackstone E.H. et al. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. Ann. Thorac. Surg. 2005; 79: 544–51. DOI: 10.1016/j.athoracsur.2004.07.047

  10. Glineur D., Papadatos S., Grau J.B., Shaw R.E., Kuschner C.E., Aphram G. et al. Complete myocardial revascularization using only bilateral internal thoracic arteries provides a low-risk and durable 10-year clinical outcome. Eur. J. Cardiothorac. Surg. 2016; 50 (4): 735–41. DOI: 10.1093/ejcts/ezw120

  11. Glineur D., Gaudino M., Grau J. The evolution of coronary bypass surgery will determine its relevance as the standard of care for the treatment for multivessel coronary artery disease. Circulation. 2016; 134: 1206–8. DOI: 10.1161/circulationaha.116.025226

  12. O’neill M.J., Wolf P.D. A rationale for the use of sequential coronary artery bypass grafts. J. Thorac. Cardiovasc. Surg. 1981; 81 (5): 686–90

  13. Nordgaard H. Transit-time blood flow measurement in sequential saphenous coronary artery bypass grafts. Ann. Thorac. Surg. 2009; 87: 1409–15. DOI: 10.1016/j.athoracsur.2009.02.018

  14. Kim H.J. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. J. Thorac. Cardiovasc. Surg. 2011; 141: 750–4. DOI: 10.1016/j.jtcvs.2010.05.037

  15. Rudenko A.V., Galich S.S., Gutovskiy V.V., Kupchinskiy A.V. Coronary bypass with sequential shunts. Herald of Cardiovascular Surgery. 2015; 23: 198–204 (in Russ.)

  16. Semchenko A.N., Bondar’ V.Yu., Andreev D.B., Shandakov P.I., Sirotsinskaya E.A., Musurivskaya T.V. et al. Results of direct myocardial revascularization with the use of sequential coronary shunting. Kardiologiya i Serdechno-Sosudistaya Khirurgiya (Cardiology and Cardiovascular Surgery). 2014; 7 (1): 21–8 (in Russ.)

  17. Sewell W.H. Should we do Y- and sequential grafts for coronary bypass? Ann. Thorc. Surg. 1978; 27: 397–8. DOI: 10.1016/s0003-4975(10)63332-2

  18. Kieser T.M. Sequential coronary bypass grafts. J. Thorac. Cardiovasc. Surg. 1986; 91: 767–72

  19. Christenson J.T. How serious is a proximal occlu- sion of a posterolateral sequential bypass? Tex. Heart Inst. J. 1996; 23: 201–6

  20. Ivanov S.V., Sotnikov A.V., Malyshenko E.S., Sumin A.N., Kazachek Ya.V., Bezdenezhnykh A.V., Barbarash L.S. Results of repeated operations of coronary shunting. Cardiology and Cardiovascular Surgery. 2014; 3: 4–11 (in Russ.)

  21. Andrew W., Sary F., Shubin S. et al. Trends in iso- lated coronary artery bypass grafting: An analysis of the Society of thoracic surgeons adult cardiac surgery database. J. Thorac. Cardiovasc. Surg. 2012; 143: 273–81. DOI: 10.1016/j.jtcvs.2011.10.029

  22. Vecherskiy Yu.Yu., Andreev S.L., Zatolokin V.V. Comparative study of the functioning of various autoarterial and foreign grafts according to shunt- ing after isolated coronary shunting. Siberian Medical Journal. 2010; 1–4: 43–9 (in Russ.)

  23. Vecherskiy Yu.Yu., Zatolokin V.V., Andreev S.L., Skurikhin I.M., Shipulin V.M. Technical aspects of nuclear arterial shunting. Siberian Medical Journal. 2015; 30 (2): 65–8 (in Russ.)

  24. Buxton B.F., Hayward P.A. The art of arterial revascularization – total arterial revascularization in patients with triple vessel coronary artery disease. Ann. Cardiothorac. Surg. 2013; 2: 543–51. DOI: 10.1016/j.jtcvs.2014.06.056

  25. Paterson H.S., Naidoo R., Byth K. et al. Full myocardial revascularization with bilateral internal mammary artery Y grafts. Ann. Cardiothorac. Surg. 2013; 2: 444–52

  26. Shneider Yu.A., Tsoy M.D., Shilenko P.A.,Khuden’kikh E.E., Cherkes A.N. The use of na-tural bifurcation of the internal thoracic arteriesin comparison with the classical sequent mam-marocoronary bypass grafting. Kardiologiya iSerdechno-Sosudistaya Khirurgiya (Cardiology andCardiovascular Surgery).2016; 9 (2): 15–8. DOI: 10.17116/kardio20169215-18 (in Russ.).15–8. 

About Authors

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


Sort by