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1.
Khirurgiia (Mosk) ; (5): 51-57, 2024.
Artículo en Ruso | MEDLINE | ID: mdl-38785239

RESUMEN

OBJECTIVE: To evaluate the clinical effectiveness of bilateral internal mammary artery grafting over long-term (15 years) postoperative period. MATERIAL AND METHODS: There were 276 patients divided into two groups: 135 patients (group A) underwent bilateral internal mammary artery grafting and 141 patients (group B) underwent unilateral internal mammary artery grafting together with venous bypass grafts. On-pump surgeries and cardioplegia, parallel CPB and on-pump procedures were performed in equal proportions. Mean age of patients was 57.3±7.6 years. Diabetes mellitus was detected in 21 (15.5%) and 24 (19.1%) patients, respectively (p>0.05). Mean LV ejection fraction was 55.4±9.9%, revascularization index - 3.1±0.8 and 3.0±0.7, respectively. In the 1st group, 43 patients underwent bilateral internal mammary artery grafting alone. Autovenous grafts were additionally used in other 84 patients. RESULTS: Ten-year survival exceeded 90% in both groups. Freedom from adverse cardiac events after 15 years was significantly higher in group A (77.3% vs. 59.3%, p=0.018). In group A, 16 patients died throughout this period due to cancer (50%), myocardial infarction (12.5%), stroke (18.8%) and complications of diabetes mellitus (6.3%). In group B, 22 patients died mainly from cardiac causes (myocardial infarction - 40.9%, cancer - 27.3%). CONCLUSION: Bilateral internal mammary artery grafting has obvious advantages over traditional coronary artery bypass grafting. If we take into account higher proportion of cardiac causes in structure of mortality in group B, we can talk about positive impact of bilateral internal mammary artery grafting not only on the quality of life, but also on life expectancy in long-term postoperative period.


Asunto(s)
Arterias Mamarias , Complicaciones Posoperatorias , Humanos , Persona de Mediana Edad , Femenino , Masculino , Arterias Mamarias/trasplante , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Federación de Rusia/epidemiología , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/complicaciones , Anastomosis Interna Mamario-Coronaria/métodos , Anastomosis Interna Mamario-Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria/efectos adversos , Resultado del Tratamiento , Calidad de Vida , Efectos Adversos a Largo Plazo/etiología , Efectos Adversos a Largo Plazo/diagnóstico , Efectos Adversos a Largo Plazo/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud
2.
Mol Cell Biochem ; 478(9): 1939-1947, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36583793

RESUMEN

Monoamine oxidases (MAOs), mitochondrial enzymes with two isoforms, A and B, have been recently recognized as significant contributors to oxidative stress in the cardiovascular system. The present study was purported to assess the effect of metformin and empagliflozin on MAO expression, oxidative stress and vascular reactivity in internal mammary arteries harvested from overweight patients with coronary heart disease subjected to bypass grafting. Vascular rings were prepared and acutely incubated (12 h) with high glucose (GLUC, 400 mg/dL) or angiotensin II (AII, 100 nM) and metformin (10 µM) and/or empagliflozin (10 µM) and used for the assessment of MAO expression (qRT-PCR and immune histochemistry), reactive oxygen species (ROS, confocal microscopy and spectrophotometry), and vasomotor function (myograph). Ex vivo stimulation with GLUC or AII increased both MAOs expression, ROS production and impaired relaxation to acetylcholine (ACh) of the vascular rings. All effects were alleviated by incubation with each antidiabetic drug; no cumulative effect was obtained when the drugs were applied together. In conclusion, MAO-A and B are upregulated in mammary arteries after acute stimulation with GLUC and AII. Endothelial dysfunction and oxidative stress were alleviated by either metformin or empagliflozin in both stimulated and non-stimulated vascular samples harvested from overweight cardiac patients.


Asunto(s)
Arterias Mamarias , Metformina , Anillo Vascular , Humanos , Especies Reactivas de Oxígeno/metabolismo , Arterias Mamarias/metabolismo , Metformina/farmacología , Sobrepeso , Estrés Oxidativo , Monoaminooxidasa/metabolismo
3.
Circ Res ; 126(12): 1746-1759, 2020 06 05.
Artículo en Inglés | MEDLINE | ID: mdl-32279581

RESUMEN

RATIONALE: Dysregulated purinergic signaling transduction plays important roles in the pathogenesis of cardiovascular diseases. However, the role and mechanism of vascular smooth muscle cell (VSMC)-released ATP in the regulation of blood pressure, and the pathogenesis of hypertension remain unknown. FAM3A (family with sequence similarity 3 member A) is a new mitochondrial protein that enhances ATP production and release. High expression of FAM3A in VSMC suggests it may play a role in regulating vascular constriction and blood pressure. OBJECTIVE: To determine the role and mechanism of FAM3A-ATP signaling pathway in VSMCs in the regulation of blood pressure and the pathogenesis of hypertension. METHODS AND RESULTS: In the media layer of hypertensive rat and mouse arteries, and the internal mammary artery of hypertensive patients, FAM3A expression was increased. VSMC-specific deletion of FAM3A reduced vessel contractility and blood pressure levels in mice. Moreover, deletion of FAM3A in VSMC attenuated Ang II (angiotensin II)-induced vascular constriction and remodeling, hypertension, and cardiac hypertrophy in mice. In cultured VSMCs, Ang II activated HSF1 (heat shock factor 1) to stimulate FAM3A expression, activating ATP-P2 receptor pathway to promote the change of VSMCs from contractile phenotype to proliferative phenotype. In the VSMC layer of spontaneously hypertensive rat arteries, Ang II-induced hypertensive mouse arteries and the internal mammary artery of hypertensive patients, HSF1 expression was increased. Treatment with HSF1 inhibitor reduced artery contractility and ameliorated hypertension of spontaneously hypertensive rats. CONCLUSIONS: FAM3A is an important regulator of vascular constriction and blood pressure. Overactivation of HSF1-FAM3A-ATP signaling cascade in VSMCs plays important roles in Ang II-induced hypertension and cardiovascular diseases. Inhibitors of HSF1 could be potentially used to treat hypertension.


Asunto(s)
Cardiomegalia/metabolismo , Citocinas/metabolismo , Hipertensión/metabolismo , Músculo Liso Vascular/metabolismo , Adenosina Trifosfato/metabolismo , Angiotensina II/farmacología , Animales , Arterias/efectos de los fármacos , Arterias/metabolismo , Arterias/fisiopatología , Presión Sanguínea , Cardiomegalia/fisiopatología , Células Cultivadas , Citocinas/genética , Femenino , Eliminación de Gen , Factores de Transcripción del Choque Térmico/metabolismo , Humanos , Hipertensión/fisiopatología , Masculino , Ratones , Ratones Endogámicos C57BL , Persona de Mediana Edad , Músculo Liso Vascular/efectos de los fármacos , Músculo Liso Vascular/fisiopatología , Miocitos del Músculo Liso/metabolismo , Ratas , Receptores Purinérgicos P2/metabolismo , Vasoconstricción , Vasoconstrictores/farmacología
4.
J Card Surg ; 37(4): 895-905, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35064710

RESUMEN

OBJECTIVE: To compare outcomes of three methods of coronary artery bypass graft surgery (CABG): robotic off-pump hybrid coronary revascularization (HCR) versus conventional CABG off-pump (off-pump coronary artery bypass [OPCAB]) and on-pump (on-pump coronary artery bypass [ONCAB]) in women. METHODS: Data on women who underwent robotic off-pump HCR or conventional OPCAB or conventional ONCAB between May 2005 and January 2021 were collected. Inverse probability of treatment weighting (IPTW) with doubly robust method was used to analyze the data. RESULTS: A total of 731 women were included (181 robotic off-pump HCR, 138 conventional ONCAB, and 412 conventional OPCAB cases). IPTW-adjusted analyses revealed the following: (1) for operative times, robotic off-pump HCR presented longer times when compared with OPCAB, but shorter times when compared with ONCAB; (2) compared with ONCAB and OPCAB, robotic off-pump HCR presented lower rates of reintervention for bleeding, intra- and postoperative blood transfusions, higher rates of extubation in the OR with less prolonged ventilation, lower rates of postoperative atrial fibrillation, and shorter intensive care unit and hospital length of stay; (3) no statistically significant differences for operative mortality were observed comparing robotic off-pump HCR with ONCAB (IPTW-adjusted odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.07-7.85; p = .822) and with OPCAB (IPTW-adjusted OR: 4.27; 95% CI: 0.27-66.88; p = .301); 4. long-term survival was similar with HCR compared with ONCAB (hazard ratio [HR]: 0.74, 95% CI: 0.36-1.50, p = .401) and OPCAB (HR: 0.89, 95% CI: 0.50-1.58, p = .683). CONCLUSIONS: In our local experience, robotic off-pump HCR in women was as safe as conventional ONCAB and OPCAB and may further improve postoperative outcomes when performed frequently by a dedicated team, producing better perioperative outcomes without compromising survival in the long run.


Asunto(s)
Puente de Arteria Coronaria Off-Pump , Enfermedad de la Arteria Coronaria , Procedimientos Quirúrgicos Robotizados , Arritmias Cardíacas , Transfusión Sanguínea , Puente de Arteria Coronaria/métodos , Puente de Arteria Coronaria Off-Pump/métodos , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Resultado del Tratamiento
5.
Int J Mol Sci ; 23(20)2022 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-36293013

RESUMEN

Albeit multiple studies demonstrated that vasa vasorum (VV) have a crucial importance in vascular pathology, the informative markers and metrics of vascular inflammation defining the development of intimal hyperplasia (IH) have been vaguely studied. Here, we employed two rat models (balloon injury of the abdominal aorta and the same intervention optionally complemented with intravenous injections of calciprotein particles) and a clinical scenario (arterial and venous conduits for coronary artery bypass graft (CABG) surgery) to investigate the pathophysiological interconnections among VV, myeloperoxidase-positive (MPO+) clusters, and IH. We found that the amounts of VV and MPO+ clusters were strongly correlated; further, MPO+ clusters density was significantly associated with balloon-induced IH and increased at calciprotein particle-provoked endothelial dysfunction. Likewise, number and density of VV correlated with IH in bypass grafts for CABG surgery at the pre-intervention stage and were higher in venous conduits which more frequently suffered from IH as compared with arterial grafts. Collectively, our results underline the pathophysiological importance of excessive VV upon the vascular injury or at the exposure to cardiovascular risk factors, highlight MPO+ clusters as an informative marker of adventitial and perivascular inflammation, and propose another mechanistic explanation of a higher long-term patency of arterial grafts upon the CABG surgery.


Asunto(s)
Adventicia , Peroxidasa , Ratas , Animales , Hiperplasia/patología , Vasa Vasorum/patología , Neovascularización Patológica/patología , Inflamación/patología
6.
J Vasc Bras ; 19: e20200042, 2020 Aug 31.
Artículo en Inglés | MEDLINE | ID: mdl-34178077

RESUMEN

Aneurysm of the internal thoracic artery is a rare entity, with variable presentation and a potential risk of fatal rupture. Angiotomography is the diagnostic test of choice and is useful for planning treatment. Considering the morbidity of thoracic access for a direct approach and the unpredictable risk of rupture, an endovascular procedure is the treatment modality of choice for this type of aneurysm. We describe the case of an internal thoracic artery aneurysm discovered incidentally during investigation of syncope and treated by embolization with low-profile and controlled-release microcoils.

7.
Cephalalgia ; 39(14): 1735-1744, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31284729

RESUMEN

BACKGROUND: Migraine is associated with activation of the trigeminovascular system, release of calcitonin gene-related peptide (CGRP) and dilation of dural arteries. Novel treatments target calcitonin gene-related peptide or its receptor, which are present in all vascular beds, raising cardiovascular concerns. Erenumab is a human CGRP-receptor antibody approved for the prophylactic treatment of migraine. METHODS: We characterised the relaxant responses to CGRP in the absence and presence of erenumab (1 µM) in isolated human middle meningeal, internal mammary and (proximal and distal) coronary arteries. Furthermore, in human internal mammary arteries from cardiovascularly-compromised patients, we assessed the pharmacological specificity of erenumab by investigating whether the vasodilatory responses to acetylcholine, sodium nitroprusside, pituitary adenylate cyclase activating polypeptide-38 (PACAP), vasoactive intestinal peptide and nicardipine, along with the vasoconstrictor responses to dihydroergotamine, were modified by erenumab. RESULTS: Calcitonin gene-related peptide induced concentration-dependent vasodilatory responses in all vessels studied that were significantly antagonised by erenumab. In human internal mammary arteries from cardiovascularly-compromised patients, the responses to acetylcholine, sodium nitroprusside, PACAP, vasoactive intestinal peptide, nicardipine and dihydroergotamine were unaffected by erenumab. CONCLUSION: Erenumab inhibits calcitonin gene-related peptide-induced vasodilatory responses in human middle meningeal arteries, human internal mammary arteries and human coronary arteries. Moreover, erenumab shows functional specificity as no interaction was observed with the relaxant responses to several vasodilators, nor the dihydroergotamine-dependent vasoconstrictor responses.


Asunto(s)
Anticuerpos Monoclonales Humanizados/farmacología , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/farmacología , Péptido Relacionado con Gen de Calcitonina/farmacología , Vasos Coronarios/efectos de los fármacos , Arterias Mamarias/efectos de los fármacos , Vasodilatadores/farmacología , Adulto , Vasos Coronarios/fisiología , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Arterias Mamarias/fisiología , Persona de Mediana Edad , Técnicas de Cultivo de Órganos , Receptores de Péptido Relacionado con el Gen de Calcitonina/fisiología
9.
Circulation ; 136(14): 1331-1345, 2017 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-28972063

RESUMEN

Coronary artery bypass grafting remains one of the most commonly performed major surgeries, with well-established symptomatic and prognostic benefits in patients with multivessel and left main coronary artery disease. This review summarizes current indications, contemporary practice, and outcomes of coronary artery bypass grafting. Despite an increasingly higher-risk profile of patients, outcomes have significantly improved over time, with significant reductions in operative mortality and perioperative complications. Five- and 10-year survival rates are ≈85% to 95% and 75%, respectively. A number of technical advances could further improve short- and long-term outcomes after coronary artery bypass grafting. Developments in off-pump and no-touch procedures; epiaortic scanning; conduit selection, including bilateral internal mammary artery and radial artery use; intraoperative graft assessment; minimally invasive procedures, including robotic-assisted surgery; and hybrid coronary revascularization are discussed.


Asunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Humanos , Resultado del Tratamiento
10.
Circulation ; 136(18): 1676-1685, 2017 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-29084776

RESUMEN

BACKGROUND: Although previous studies have demonstrated that patients receiving bilateral internal mammary artery (BIMA) conduits during coronary artery bypass grafting have better long-term survival than those receiving a single internal mammary artery (SIMA), data on risk of repeat revascularization are more limited. In this analysis, we compare the timing, frequency, and type of repeat coronary revascularization among patients receiving BIMA and SIMA. METHODS: We conducted a multicenter, retrospective analysis of 47 984 consecutive coronary artery bypass grafting surgeries performed from 1992 to 2014 among 7 medical centers reporting to a prospectively maintained clinical registry. Among the study population, 1482 coronary artery bypass grafting surgeries with BIMA were identified, and 1297 patients receiving BIMA were propensity-matched to 1297 patients receiving SIMA. The primary end point was freedom from repeat coronary revascularization. RESULTS: The median duration of follow-up was 13.2 (IQR, 7.4-17.7) years. Patients were well matched by age, body mass index, major comorbidities, and cardiac function. There was a higher freedom from repeat revascularization among patients receiving BIMA than among patients receiving SIMA (hazard ratio [HR], 0.78 [95% CI, 0.65-0.94]; P=0.009). Among the matched cohort, 19.4% (n=252) of patients receiving SIMA underwent repeat revascularization, whereas this frequency was 15.1% (n=196) among patients receiving BIMA (P=0.004). The majority of repeat revascularization procedures were percutaneous coronary interventions (94.2%), and this did not differ between groups (P=0.274). Groups also did not differ in the ratio of native versus graft vessel percutaneous coronary intervention (P=0.899), or regarding percutaneous coronary intervention target vessels; the most common targets in both groups were the right coronary (P=0.133) and circumflex arteries (P=0.093). In comparison with SIMA, BIMA grafting was associated with a reduction in all-cause mortality at 12 years of follow-up (HR, 0.79 [95% CI, 0.69-0.91]; P=0.001), and there was no difference in in-hospital morbidity. CONCLUSIONS: BIMA grafting was associated with a reduced risk of repeat revascularization and an improvement in long-term survival and should be considered more frequently during coronary artery bypass grafting.


Asunto(s)
Puente de Arteria Coronaria , Arterias Mamarias , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios Retrospectivos , Tasa de Supervivencia
11.
Circulation ; 133(2): 131-8, 2016 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-26647082

RESUMEN

BACKGROUND: The internal mammary artery (IMA) is the preferred conduit for bypassing the left anterior descending (LAD) artery in patients undergoing coronary artery bypass grafting. Systematic evaluation of the frequency and predictors of IMA failure and long-term outcomes is lacking. METHODS AND RESULTS: The Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV trial participants who underwent IMA-LAD revascularization and had 12- to 18-month angiographic follow-up (n=1539) were included. Logistic regression with fast false selection rate methods was used to identify characteristics associated with IMA failure (≥75% stenosis). The relationship between IMA failure and long-term outcomes, including death, myocardial infarction, and repeat revascularization, was assessed with Cox regression. IMA failure occurred in 132 participants (8.6%). Predictors of IMA graft failure were LAD stenosis <75% (odds ratio, 1.76; 95% confidence interval, 1.19-2.59), additional bypass graft to diagonal branch (odds ratio, 1.92; 95% confidence interval, 1.33-2.76), and not having diabetes mellitus (odds ratio, 1.82; 95% confidence interval, 1.20-2.78). LAD stenosis and additional diagonal graft remained predictive of IMA failure in an alternative model that included angiographic failure or death before angiography as the outcome. IMA failure was associated with a significantly higher incidence of subsequent acute (<14 days of angiography) clinical events, mostly as a result of a higher rate of repeat revascularization. CONCLUSIONS: IMA failure was common and associated with higher rates of repeat revascularization, and patients with intermediate LAD stenosis or with an additional bypass graft to the diagonal branch had increased risk for IMA failure. These findings raise concerns about competitive flow and the benefit of coronary artery bypass grafting in intermediate LAD stenosis without functional evidence of ischemia. CLINICAL TRIAL REGISTRATION: URL: http:/www.clinicaltrials.gov. Unique identifier: NCT00042081.


Asunto(s)
Anastomosis Interna Mamario-Coronaria/estadística & datos numéricos , Anciano , Cateterismo Cardíaco , Fármacos Cardiovasculares/uso terapéutico , Terapia Combinada , Comorbilidad , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/cirugía , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/epidemiología , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/cirugía , Método Doble Ciego , Femenino , Oclusión de Injerto Vascular/epidemiología , Humanos , Anastomosis Interna Mamario-Coronaria/efectos adversos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Infarto del Miocardio/epidemiología , Complicaciones Posoperatorias/mortalidad , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación , Insuficiencia del Tratamiento
12.
World J Surg Oncol ; 15(1): 111, 2017 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-28558811

RESUMEN

BACKGROUND: Breast cancer can be diagnosed easily in most cases. However, occasionally, we are faced with some conditions that can mimic it. These may include inflammations, benign tumors, cysts, hematomas, or, more rarely, focal necrosis. CASE PRESENTATION: This report presents a case of focal breast necrosis following myocardial revascularization with the left internal mammary artery, which is a very rare condition, with only few cases described in the literature. The necrosis becomes usually apparent a few days or weeks after the surgery and is often coincidental with the dehiscence of sternotomy with necrosis of wound edges. As it mostly affects the skin, it can be easily recognized. Also, our patient developed a dehisced sternotomy shortly after the surgery but there were no obvious objective changes on the breast. The condition was first dominated only by non-specific subjective symptom-pain. Later, a lump in the breast occurred, when the sternotomy had already healed. Moreover, an enlarged lymph node was palpable in the axilla. Because of non-typical symptoms, the condition was suggestive of breast cancer for a relatively long time. The patient had suffered from a very strong pain until she was treated by mastectomy with a good clinical result. CONCLUSIONS: Mammary necrosis following the coronary artery bypass is rare. In most cases, it manifests on the skin shortly after the surgery concurrently with dehisced sternotomy, so it can be easily diagnosed. However, in sporadic cases, the symptoms may occur later and may mimic breast cancer. Our objective is to raise awareness of this rare condition.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Mama/patología , Puente de Arteria Coronaria/efectos adversos , Arterias Mamarias/cirugía , Anciano , Mama/irrigación sanguínea , Mama/cirugía , Neoplasias de la Mama/etiología , Femenino , Humanos , Necrosis , Pronóstico
13.
Folia Morphol (Warsz) ; 76(1): 117-122, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27830889

RESUMEN

BACKGROUND: The purpose of this study is to describe the vascularised anterior rib flap on sectioned images and surface models using Visible Korean for medical education and clinical training in the field of mandibular reconstructive surgery. MATERIALS AND METHODS: Serially sectioned images of the thorax were obtained from a cadaver. Significant structures in the sectioned images were outlined and stacked to create a surface model. RESULTS: The PDF file (8.45 MB) of the assembled models can be downloaded for free from our website (http://vkh.ajou.ac.kr/Products/PDF/Vascularized_anterior_rib_flap.zip). In this file, important anatomical structures related to the vascularised anterior rib flap can be examined in the sectioned images. All surface models and stereoscopic structures of the vascularised anterior rib flap are expressed in real time. CONCLUSIONS: We hope that these state-of-the-art sectioned images, outlined images, and surface models will help students and trainees gain a better understanding of the anatomy of the vascularised anterior rib flap.


Asunto(s)
Imagenología Tridimensional , Modelos Anatómicos , Costillas , Programas Informáticos , Colgajos Quirúrgicos , Cadáver , Femenino , Humanos , Masculino
14.
Pol J Radiol ; 82: 660-663, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29657631

RESUMEN

BACKGROUND: We aimed to compare the frequency of IMA (internal mammarian artery) anastomoses in right and left breasts in patients without breast lesions and in patients with malignant breast lesions. MATERIAL/METHODS: A total of 100 patients with no breast lesions and a total of 100 patients with malignant breast lesions were included in the study. The anastomoses of IMA of right and left breasts were evaluated on MIP and post-contrast T1-weighted magnetic resonance imaging (MRI) sequences. Breast MRI scans were read by a radiologist. RESULTS: In patients with no breast lesions, IMA anastomoses were found in 45% of cases, and in patients with malignant breast lesions, IMA anastomoses were found in 58% cases. In four patients with malignant lesions, ipsilateral IMA was rudimentary, and the lesion was feeding from the contralateral IMA. CONCLUSIONS: No statistically significant difference was found between patients without any breast lesions and patients with malignant breast lesions with respect to the frequency of IMA anastomoses in right and left breasts. The frequencies were higher than expected in both groups.

15.
Circulation ; 129(25): 2645-52, 2014 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-24744276

RESUMEN

BACKGROUND: The function of naturally existing internal mammary (IMA)-to-coronary artery bypasses and their quantitative effect on myocardial ischemia are unknown. METHODS AND RESULTS: The primary end point of this study was collateral flow index (CFI) obtained during two 1-minute coronary artery balloon occlusions, the first with and the second without simultaneous distal IMA occlusion. The secondary study end point was the quantitatively determined intracoronary ECG ST-segment elevation. CFI is the ratio of simultaneously recorded mean coronary occlusive pressure divided by mean aortic pressure both subtracted by mean central venous pressure. A total of 180 pairs of CFI measurements were performed among 120 patients. With and without IMA occlusion, CFI was 0.110±0.074 and 0.096±0.072, respectively (P<0.0001). The difference of CFI obtained in the presence minus CFI obtained in the absence of IMA occlusion was highest and most consistently positive during left IMA with left anterior descending artery occlusion and during right IMA with right coronary artery occlusion (ipsilateral occlusions): 0.033±0.044 and 0.025±0.027, respectively. This CFI difference was absent during right IMA with left anterior descending artery occlusion and during left IMA with right coronary artery occlusion (contralateral occlusions): -0.007±0.034 and 0.001±0.023, respectively (P=0.0002 versus ipsilateral occlusions). The respective CFI differences during either IMA with left circumflex artery occlusion were inconsistently positive. Intracoronary ECG ST-segment elevations were significantly reduced during ipsilateral IMA occlusions but not during contralateral or left circumflex artery occlusions. CONCLUSION: There is a functional, ischemia-reducing extracardiac coronary artery supply via ipsilateral but not via contralateral natural IMA bypasses. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCTO1676207.


Asunto(s)
Circulación Colateral/fisiología , Oclusión Coronaria/fisiopatología , Vasos Coronarios/fisiología , Arterias Mamarias/fisiología , Isquemia Miocárdica/prevención & control , Isquemia Miocárdica/fisiopatología , Anciano , Angiografía , Presión Sanguínea/fisiología , Angiografía Coronaria , Oclusión Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Electrocardiografía , Determinación de Punto Final , Femenino , Humanos , Masculino , Arterias Mamarias/diagnóstico por imagen , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
16.
Circulation ; 130(7): 539-45, 2014 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-24916209

RESUMEN

BACKGROUND: Although the potential survival benefit of bilateral internal mammary artery (BIMA) grafting in comparison with single internal mammary artery (SIMA) grafting has been emphasized by many investigators, the use of BIMA is still low in clinical practice in the absence of randomized trials and long-term results. In the current study, we aimed to assess if there is a long-term survival benefit of BIMA up to 10 years after coronary bypass surgery. METHODS AND RESULTS: We selected published articles comparing survival between SIMA and BIMA patients with follow-up duration of more than a mean of 9 years. We evaluated the log hazard ratio with 95% confidence interval for included studies by using a random-effects meta-analysis. Nine eligible observational studies provided 15 583 patients (8270 SIMA and 7313 BIMA) for meta-analysis. Five studies used propensity score methods for statistical adjustment, 2 with a propensity score-based patient-matching method and 3 with quintile-based stratification. A significant reduction in mortality by using BIMA was observed (hazard ratio, 0.79; 95% confidence interval, 0.75-0.84); no study showed any significantly harmful effect of BIMA on survival. Subgroups of studies using different statistical approaches-unmatched, quintile-based propensity score analysis, and propensity score-based exact patient matching-all showed the survival benefit of BIMA grafting. CONCLUSIONS: BIMA grafting appears to have better survival with up to 10 years follow-up in comparison with SIMA grafting. Long-term survival benefit of BIMA seems to continue in the second decade after surgery. An ongoing randomized trial comparing SIMA and BIMA groups will add evidence on this issue.


Asunto(s)
Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Anastomosis Interna Mamario-Coronaria/mortalidad , Arterias Mamarias/trasplante , Puente de Arteria Coronaria/mortalidad , Puente de Arteria Coronaria/tendencias , Enfermedad de la Arteria Coronaria/epidemiología , Humanos , Anastomosis Interna Mamario-Coronaria/tendencias , Tasa de Supervivencia/tendencias , Resultado del Tratamiento
17.
Heart Lung Circ ; 23(12): 1179-86, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25017042

RESUMEN

OBJECTIVE: To compare the safety of procedure in patients receiving right internal mammary artery (RIMA) versus radial artery (RA) as the second arterial graft during left internal mammary artery bypass surgery. METHODS: A literature search was performed, and observational studies comparing RA and RIMA as a second arterial conduit were included. The end points included in-hospital mortality, sternal wound infection (SWI), myocardial infarction (MI), reoperation for bleeding, stroke and low cardiac output syndrome. Sensitivity analysis was performed, and publication bias was assessed. RESULTS: Analysis of nine studies comprising 1,738 RIMA patients and 1,906 RA patients showed a similar risk of in-hospital mortality (relative risk [RR] 1.13, 95% confidence interval [CI] 0.64 to 1.98) between two groups. The risk of SWI in RIMA patients was significantly higher than that in RA patients (RR 3.19, 95% CI 1.64 to 6.20). The risk of the rest end points did not differ. CONCLUSIONS: The postoperative risk seems to be similar between RIMA group and RA group, except the higher risk of SWI in RIMA patients. The surgeon relies on his own experience with these two arterial grafts and assessment of the patient profile to decide the choice of the second arterial conduit.


Asunto(s)
Puente de Arteria Coronaria/métodos , Arterias Mamarias , Complicaciones Posoperatorias/mortalidad , Arteria Radial , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Factores de Riesgo
18.
Circ Cardiovasc Qual Outcomes ; 17(1): e007803, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38189126

RESUMEN

BACKGROUND: Propensity score methods are used in observational studies to compensate for the lack of random allocation by balancing measured baseline characteristics between treated and untreated patients. We sought to explain the treatment effect estimates derived from different propensity score methods. METHODS: We performed a retrospective analysis of long-term mortality after single internal mammary artery versus bilateral internal mammary artery (BIMA) conduit in 47 984 index isolated coronary artery bypass grafting procedures from 1992 to 2014 in the Northern New England Cardiovascular Disease Study Group registry using multivariable Cox regression, 1:1 propensity score matching, inverse probability weighting (IPW) among the treated, and IPW among the overall population treatment estimates. RESULTS: The mean duration of follow-up was 13.2 (interquartile range, 7.4-17.7) years. In multivariable Cox regression, the adjusted hazard ratio for mortality was 0.83 (95% CI, 0.75-0.92) in patients receiving BIMA compared with a single internal mammary artery. The 1:1 propensity matched (hazard ratio, 0.79 [95% CI, 0.69-0.91]) and IPW among the treated (hazard ratio, 0.83 [95% CI, 0.75-0.92]) estimates showed a protective treatment effect of BIMA use on mortality. However, the IPW estimate of treatment effect for the overall population showed an increased risk of mortality after BIMA that was not statistically significant (hazard ratio, 1.08 [95% CI, 0.94-1.24]). CONCLUSIONS: While the multivariable Cox regression, 1:1 propensity matching, and IPW treatment effect in the treated estimates demonstrate that BIMA was associated with a statistically significantly decreased risk of mortality, the IPW treatment effect in the average study population showed an increased risk of mortality associated with BIMA that was not statistically significant. This is attributed to the different populations (weighted to look like the overall study population versus treated group) represented by the 2 IPW approaches. Determining how the study population is balanced is a large driver of the treatment effect. Ultimately, the treatment effect estimate desired should drive the choice of the propensity score method.


Asunto(s)
Enfermedad de la Arteria Coronaria , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/terapia , Estudios Retrospectivos , Puntaje de Propensión , Puente de Arteria Coronaria/efectos adversos , Modelos de Riesgos Proporcionales , Resultado del Tratamiento
20.
Braz J Cardiovasc Surg ; 38(2): 244-247, 2023 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-36692045

RESUMEN

INTRODUCTION: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of coronary artery bypass grafting (CABG). This grafting has led to an increased use of other arterial conduits, of which the radial artery (RA) is the most popular. Whether RA can have the same long-term patency as LITA is controversial. The objective of this study is to access the long-term clinical follow-up and, when available, the patency rate of RA grafts. METHODS: Twenty-six patients from a previous study with critical stenosis in all target vessels underwent complete arterial CABG with LITA and RA grafts from 1996 to 2003. They all underwent midterm multidetector computed tomography after surgery with the association of at least one patent LITA and one patent RA graft. RESULTS: Twelve patients (46%) are alive with no angina symptoms. Six patients underwent a second image exam 12 to 16 years (average of 14 years) after surgery, with a total of six LITA-LADA and 14 RA grafts with 100% patency rate. Clinical follow-up five to 23 years after surgery (average of 14 years) showed only one death 12 years after surgery related to coronary artery disease (CAD) (3,8%). Another 12 patients died of non-CAD. CONCLUSION: Patients with midterm associated LITA and RA patent grafts show similar optimal long-term patency rates of both types of grafts with excellent clinical outcome.


Asunto(s)
Enfermedad de la Arteria Coronaria , Arterias Mamarias , Humanos , Arteria Radial/trasplante , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/cirugía , Arterias Mamarias/trasplante
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