ABSTRACT
This study was designed to assess the role of macrophages in saphenous vein graft disease after coronary artery bypass grafting (CABG). Three newly harvested saphenous vein grafts (SVGs) and 6 SVGs removed from patients 8 to 15 years after CABG (3 were occluded soon after the operation and 3 became diseased after a long period) were immunostained for macrophages and investigated microscopically. No macrophages were detected in the newly harvested SVGs. In the grafts with early occlusion, macrophages were detected only in the superficial layer of the intima. In the grafts that became diseased after a long period, macrophage accumulation was detected at the site of atherosclerotic lesions. In the pathogenesis of arterial atherosclerotic lesions, vascular endothelial cell damage and subsequent subendothelial migration of monocytes/macrophages in the early phase are thought to be very important. This study revealed that macrophage migration into the intima of SVGs occurs soon after surgery and suggested it could be the basis of saphenous vein graft disease occurring long after CABG.
ABSTRACT
Although left anterior descending coronary artery (LAD) grafting with a left internal thoracic artery (ITA) on a beating heart via a small left anterior thoracotomy (LAST) has become widely accepted, significant limitations exist due to the limited surgeon experience, smallness of exposure, thus making harvesting of the ITA, visualization of the surgical field and anastomosis quite difficult. Patients often have significant pain and wound complications postoperatively. A lower mini-sternotomy approach in 4 patients was performed from December 1998 through January 1999. Results: The length of mini-sternotomy incision is 7 to 14cm. These operations were accomplished without morbidity or mortality. No patients required intraoperative conversion to conventional bypass. Postoperative angiography showed patency of graft without stenosis of the anastomosis in all 4 patients. The patients did not complain of significant pain and their postoperative hospital stay was 5 to 11 days. The lower mini-sternotomy approach or“xyphoid” approach proposed by Benetti seems to be an excellent novel approach giving the freedom of extension of the incision if needed with satisfactory exposure for left ITA harvest and access to LAD as well as the distal RCA, and causes less postoperative incisional pain.
ABSTRACT
The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; <i>n</i>=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; <i>n</i>=35), and those who were 60 years or younger and received rHuEPO (group III; <i>n</i>=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (<i>p</i><0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (<i>p</i><0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.