Flow dynamics in internal thoracic artery grafts 10 years after coronary artery bypass grafting.

BACKGROUND: Flow dynamics in internal thoracic artery grafts 10 years after surgery are not known. METHODS: Doppler examination was performed in native internal thoracic arteries as a control (n = 8) and in internal thoracic artery grafts to the left anterior descending coronary artery 6 months postoperatively (group A, n = 25), at 5 years (group B, n = 14), and at 10 years (group C, n = 11). RESULTS: Each graft group showed a diastolic to systolic peak velocity ratio of less than 1.0 at the proximal end, and more than 1.0 at the distal end, but the control group showed a ratio of less than 1.0 throughout the length of the artery. The diastolic peak velocity of the graft groups was significantly faster than that of the control group at the distal end (versus group A, p < 0.01; versus group B, p < 0.005; and versus group C, p < 0.05). The systolic peak velocity of the graft groups was significantly lower than that of the control at the proximal end (versus group A, p < 0.0001; versus group B, p < 0.005; and versus group C, p < 0.0005). There were no significant differences of flow velocities among the graft groups and graft diameter among the four groups. CONCLUSIONS: Although the internal thoracic artery is systolic predominant, when native artery is used as graft, it changes its hemodynamics to diastolic predominance, especially at the distal end. Even after 10 years, graft flow dynamics are unchanged. This hemodynamic character may be one of the factors related to the superior long-term patency.

Long-term clinical outcomes for patients with lower limb ischemia implanted with G-CSF-mobilized autologous peripheral blood mononuclear cells.

BACKGROUND: Many studies have described the clinical effects of treating critical limb ischemia with granulocyte colony-stimulating factor-mobilized autologous peripheral blood mononuclear cells (M-PBMNC); however, there are no long-term data available on survival, limb salvage, or prognostic factors. METHODS: To investigate the long-term clinical outcomes of M-PBMNC implantation, we reviewed data for 162 consecutive patients with limb ischemia who were treated with M-PBMNC implantation at 6 hospitals between 2001 and 2006. A subset of 123 patients with homogenous clinical profiles was selected for prognostic factor analysis. RESULTS: Of the 162 patients, 50 died during the follow-up period. The median follow-up time for surviving patients was 26.4 months. The 2-year survival rate was 65% for the 140 patients with arteriosclerosis obliterans (ASO), and 100% for the 11, 4 and 7 patients with thromboangiitis obliterans (TAO), diabetic gangrene (DG) and connective tissue disease (CTD), respectively. The 1-year amputation-free rates for ASO, TAO, DG and CTD were 70%, 79%, 75% and 83%, respectively. Common serious adverse events included heart failure (15 cases), myocardial infarction (15 cases), serious infection (13 cases), stroke (10 cases), and malignant tumor (9 cases). Significant negative prognostic factors associated with overall survival were ischemic heart disease and collection of a small number of CD34-positive cells. Factors associated with time-to-amputation and amputation-free survival were a combination of Fontaine classification and lower limb gangrene, and history of dialysis. CONCLUSIONS: Collection of a small number of CD34-positive cells and ischemic heart disease were associated with a reduction in overall survival.

Repairing of infarcted myocardium using a novel cell patch therapy.

A 54-year-old man underwent left anterior descending artery bypass grafting with cell patch therapy for myocardial infarction. We applied a novel approach to replicating the infarcted myocardium by anchoring polyglycolic acid felt seeded with autologous peripheral blood mononuclear cells in front of the infarcted area. The cell patch remained fixed to the myocardium for 1 month, and the infarcted myocardium was reperfused.

Chronic contained rupture of abdominal aortic aneurysm.

Computed tomography in a 74-year-old man with intermittent claudication revealed an abdominal aortic aneurysm, retroperitoneal hematoma, vertebral erosion, and total aortic occlusion. Surgery was delayed for 9 months after definitive diagnosis of contained rupture of the aortic aneurysm to allow treatment for ischemic heart disease and cardiac failure. After interposing a Y-shaped woven Dacron graft, the intermittent claudication was alleviated. The postoperative course was uneventful.

Long-term outcomes using vascular grafts sealed with fragmented autologous adipose tissue for aortoiliac occlusive disease.

The aim of this study was to test the safety and efficacy of fragmented autologous adipose tissue (FAT) grafts for revascularization in aortoiliac occlusive disease. Twenty-seven patients with atherosclerotic aortoiliac occlusive disease underwent surgical treatment using FAT grafts. A piece of adipose connective tissue was obtained from the operative wound, cut into small pieces, and pressed into the wall of a fabric vascular prosthesis. Cumulative primary patency rates were 92% at 1 year, 92% at 3 years, and 86% at 6 years. Cumulative secondary patency rates were 96%, 96%, and 90% for the same intervals. In this clinical study, the FAT grafts demonstrated good long-term patency rates and no particular problems. This is the first clinical report of long-term outcomes using FAT grafts for aortofemoral or aortoiliac bypasses. FAT grafts are thus safe for revascularization in aortoiliac occlusive disease.

Using fascia lata to treat infective aortic false aneurysm.

In patients with infective aortic false aneurysms, repair using artificial materials is in danger of becoming an additional focus for infection. We used harvested autologous fascia lata as a vascular patch in such operations on 2 patients with infected mediastinal false aneurysm after coronary artery bypass surgery. These patients have not had any recurrences of mediastinitis and false aneurysm for 4 to 6 years after the operations.

Surgical case of isolated pulmonary Takayasu's arteritis.

Involvement of the pulmonary arteries is common in systemic Takayasu's arteritis, but pulmonary arteritis alone is very rare. A 67-year-old woman had severe right pulmonary artery stenosis and left pulmonary arterial obstruction caused by Takayasu's arteritis. Surgical treatment was successfully performed with extracorporeal circulation, without transection of the ascending aorta and the right pulmonary artery was enlarged with an autologous pericardial patch.

Experience with expanded polytetrafluoroethylene (ePTFE Gore-Tex) surgical membrane for coronary artery grafting: does ePTFE surgical membrane predispose to postoperative mediastinitis?

The advantage of completely closing the pericardium after a coronary artery bypass grafting is the avoidance of injury of the heart and grafts during a re-operation. However, it would obviously be counterproductive to close the pericardium with a substitute that is predisposed to infection. This study was designed to evaluate the safety of ePTFE surgical membrane in comparison to native pericardium or autologous tissue. Between January 1992 to March 2003, 695 coronary artery bypass graftings were performed. The hearts and grafts were covered with ePTFE surgical membrane (474 cases: ePTFE group), or autologous pericardium and/or other autologous tissue (221 cases: non-ePTFE group). Often, a bilateral dissection of the internal thoracic artery was performed, which lengthened the surgery, the cardiopulmonary bypass, and the aortic clamp, in the ePTFE group. But there was no difference between the ePTFE group (2.1%) and the non-ePTFE group (3.2%) in the development of postoperative mediastinitis. There was also no difference between the two groups in the organism type of the infection. Methicillin resistant Staphylococcus aureus (MRSA) is the most common organism cultured from sternal wound infections; there were five cases in the ePTFE group, and four cases in the non-ePTFE group. In the ePTFE group, the hospital mortality due to postoperative mediastinitis was zero, and there was also no significant difference between the ePTFE group and the non-ePTFE group in time from the drainage operation to discharge; 74.3 days in the ePTFE group, and 81.0 days in the non-ePTFE group. The clinical use of ePTFE surgical membrane for a coronary artery bypass grafting does not appear to be a risk factor for mediastinitis.