A new strategy of total arterial revascularization.

We report a new strategy of total arterial revascularization based on bilateral internal thoracic arteries (ITAs) and a radial artery (RA). The technique employs a graft extension of the proximal third of the right internal thoracic artery (RITA) with the RA, in combination with the T-graft technique, by which the lower two-thirds of the free RITA is anastomosed to the side of the left internal thoracic artery (LITA).

Coronary artery surgery with induced temporary asystole and intermittent ventricular pacing: an experimental study.

Coronary artery bypass grafting performed without cardiopulmonary bypass presents a difficulty in performing coronary anastomoses on a beating heart. A non-cardiopulmonary bypass technique in sheep by which individual sutures can be placed on a still heart is described. Epicardial pacing wires were placed and a curved needle passed between the aorta and pulmonary artery into the muscular interventricular septum and directed caudally and to the right. The tip of the needle now lay in the vicinity of the outflow of the bundle of His. No cardiac chamber or vital structures were traversed. Injection of lignocaine here resulted in immediate ventricular asystole. Ventricular pacing restored cardiac output. After establishing local control of the vessel coronary anastomosis was performed stopping ventricular pacing for the few seconds required to place a single suture and reinstating it between the passage of sutures. Reversion to sinus rhythm occurred spontaneously.

Coronary artery baroreceptor-mediated changes in arterial pressure: a pilot study in conscious and anaesthetized sheep.

1. Evidence suggesting the presence of coronary artery baroreceptors on coronary arteries has existed for over 30 years. 2. Evidence that activation of ventricular mechanoreceptors can elicit cardiovascular changes has been challenged, with those changes now thought to be due to coronary artery mechanoreceptors. 3. Studies have suggested that coronary artery mechanoreceptors act as coronary baroreceptors with a role in cardiovascular regulation. However, all evidence to date has been obtained in anaesthetized animal models in physiologically compromised intra-operative states. 4. The purpose of the present study was to design an ovine model that would allow the discrete stretch of coronary arteries without causing ischaemia or changing flow or intra-arterial pressure and that would confirm results seen in previous studies. In addition, the possibility that the technique could be used for studies of coronary artery baroreflexes in conscious sheep was investigated. 5. Controlled stretch of the proximal left anterior descending coronary artery elicited decreases in arterial pressure without changes in heart rate or electrocardiographic activity in halothane-anaesthetized sheep. Similar results were demonstrated in conscious sheep after surgical recovery of up to 2 weeks. 6. The present study supports the possibility that coronary artery baroreceptors exist and likely have a role in cardiovascular regulation. The results of the present study in anaesthetized sheep are in agreement with previous results in anaesthetized animals, but also provide the first demonstration of coronary baroreceptor activity in a conscious animal model, underscoring the potential use of the model in the study of coronary artery baroreceptors in the intact animal.