Clinical Analysis of Left Ventrical Total Artery Revascularization with "T"-type Anasto-mosis of Left Internal Mammary Artery and Radial Artery on Pump_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIJin-dong , WUYan-hong , DONGMing-feng , WANGJian-tang , CAIShou-dong , TANGPei-zhe , LIUTao , LIZhen-kun , XIAFeng , MASheng-jun

Department of Cardiac Surgery of Liaocheng People Hospital, Liaocheng 252000 Shandong, P. R. China;

Corresponding author：

LIJin-dong, Email: jindongli_2008@126.com

Keywords：

Coronary artery bypass grafting; Radial atrtery; Total artery revascularization; On pump

DOI：

10.7507/1007-4848.20160254

Video：

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Objective To asses the clinical result of left ventrical total artery revascularization with "T"-type anastomosis of left internal mammary artery (LIMA) and radial artery on pump. Methods We retrospectively analyzed the clinical data of 40 patients who underwent left ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump in our hospital between December 2013 and December 2015 year. There were 27 males and 13 females at age of 46-70 (55.0±10.2) years. The radial artery anastomosis was made sequentially to the left obtuse artery, intermediate artery, diagonal artery and left anterior descending artery. LIMA anastomosis was made to the radial artery closed to the left anterior descending artery. Saphenous vein (SV) anastomosis was made to right coronary artery. LIMA blood flow was measured with coronary artery Butterfly Flowmeter when LIMA was in suit and after operation. cTnI was measured at different time points. Complications after operation were studied. Results The blood flow of LIMA after operation was significantly different from that in suit (P < 0.05). The plasm cTnI postoperation was higher than that preoperation, but the difference was not significant. All the patients were survival. Atrial fibrillation occurred in 2 patients and low cardiac output occurred in 1 patient after operation, but they recovered quickly after proper treatment. There was no myocardial infraction or hand ischemia during postoperation. There was no recurrence of mycardial infarction within 6 months to 1 year follow-up. Graft patency was assessed using 128-slice CT coronary angiography in 25 patients. Cumulative graft patency rates were 96.0% in LIMA and 90.4% in SV grafts. Conclusion Left ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump is safe and effective.

Citation： LIJin-dong, WUYan-hong, DONGMing-feng, WANGJian-tang, CAIShou-dong, TANGPei-zhe, LIUTao, LIZhen-kun, XIAFeng, MASheng-jun. Clinical Analysis of Left Ventrical Total Artery Revascularization with "T"-type Anasto-mosis of Left Internal Mammary Artery and Radial Artery on Pump. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(11): 1082-1085. doi: 10.7507/1007-4848.20160254 Copy

1.	Toshihiro F, Minoru T, Masataka T, et al. Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg, 2011, 91(2): 445-451．.
2.	Tranbaugh RF, Dimitrova KR, Friedmann P, et al. Coronary artery bypass grafting using the radial artery: clinical outcome patency and need for reintervention. Circulation, 2012, 126(11 Suppl 1): S170-S175.
3.	Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: result from RAPS (Radial artery patency study). Am Coll Cardiol, 2012, 60(1): 28-35.
4.	董明亮, 李清宝, 李德才, 等.非体外循环下左乳内动脉、桡动脉全动脉化冠状动脉旁路移植术的流量探讨.山东大学学报(医学版), 2013, 51(4): 47-50.
5.	Ferrari ER, Von Segesser LK. Artrial grafting for myocardial revascularization: how better is it? Curr Opin Cardiol, 2006, 21(6): 584-588.
6.	Pevni D, Mohr R, Lev-Ran O, et al. Technical aspects of composite arterial grafting with double skeletonized internal thoracic arteries. Chest, 2005, 123(5): 1348-1354.
7.	Cable DG, Caccitolo JA, Pearson PJ, et al. New approaches to prev-ention and treatment of radial artery graft vasospasm. Circulation, 1998, 98(19 Suppl): 1115-1122.
8.	陶登顺, 汪曾炜, 王辉山, 等.内皮型一氧化氮合酶基因转染防治移植静脉再狭窄的实验研究.中华外科杂志, 2005, 43(5): 657-658.
9.	陶登顺, 王辉山.冠状动脉旁路移植术后血管桥再狭窄的机制及防治现状.心脏杂志, 2006, 18(5): 585-587.
10.	陶登顺, 王辉山, 汪曾炜, 等.兔颈静脉动脉化后血管的重塑机制.第四军医大学学报, 2006, 25(14): 1456-1458.
11.	Baskett RJ, Cafferty FH, Powell SJ, et al. Total artenal revasculariza-tion is safe: Multicenter ten-year analysis of 71, 470 coronary procedures. Ann Thorac Surg, 2006, 81(4): 1243-1248.
12.	Tranbaugh RF, Dimitrova KR, Friedmann P, et al. Radial artery conduits improve long-term survival after coronary artery bypass grafting. Ann Thorac Surg, 2010, 90(4): 1165-1172.
13.	Hortmann HC, Oliveira HG, Rabello RR, et al. Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting postoperative with return of the symptoms. Rev Bras Cir Cardiovasc, 2010, 25(2): 218-223.
14.	Ivana P, Dusko N, Miodrag P, et al. Radial artery vs saphenous vein graft used as the second conduit for surgical myocardial revascularization: long-term clinical follow-up. J Cardiothorac Surg, 2015, 10: 127-133.
15.	Won-Chol C, Joon BK, Sung HJ, et al. Revascularization of the left anterior descending artery area using a single left internal thoracic artery: Auto-Y composite graftingor sequential bypassing. J Thorac Cardiovasc Surg, 2011, 142(6): 1464-1468．.
16.	万峰, 王京生, 主编.现代冠心病外科治疗学.北京:中国协和医科大学出版社, 2003. 28-38．.
17.	Lemma M, Gelpi G, Mangini A, et al. Myocardial revascularization with multiple arterial grafts: comparison between the radial artery. Ann Thorac Surg, 2001, 71(6): 1969-1973.
18.	William R, Burfeind JR, Donald D, et al. Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial. Circulation, 2004, 110(1): 1127-1135.
19.	Calafior AM, Di Giammarco G, Luciani N, et al. Composite artrial conduits for a wider artrial myocardial rvascularization. Ann Thorac Surg, 1994, 58(1): 185-190.
20.	Gaudino M, Di Mauro M, Iacò AL, et al. Immediat flow reserve of Y thoracic artry grafts' an intraoperative flow metric study. Thorac Cardiovasc Surg, 2003, 126(4): 1076-1079.

1. Toshihiro F, Minoru T, Masataka T, et al. Extensive reconstruction of the left anterior descending coronary artery with an internal thoracic artery graft. Ann Thorac Surg, 2011, 91(2): 445-451．.
2. Tranbaugh RF, Dimitrova KR, Friedmann P, et al. Coronary artery bypass grafting using the radial artery: clinical outcome patency and need for reintervention. Circulation, 2012, 126(11 Suppl 1): S170-S175.
3. Deb S, Cohen EA, Singh SK, et al. Radial artery and saphenous vein patency more than 5 years after coronary artery bypass surgery: result from RAPS (Radial artery patency study). Am Coll Cardiol, 2012, 60(1): 28-35.
4. 董明亮, 李清宝, 李德才, 等.非体外循环下左乳内动脉、桡动脉全动脉化冠状动脉旁路移植术的流量探讨.山东大学学报(医学版), 2013, 51(4): 47-50.
5. Ferrari ER, Von Segesser LK. Artrial grafting for myocardial revascularization: how better is it? Curr Opin Cardiol, 2006, 21(6): 584-588.
6. Pevni D, Mohr R, Lev-Ran O, et al. Technical aspects of composite arterial grafting with double skeletonized internal thoracic arteries. Chest, 2005, 123(5): 1348-1354.
7. Cable DG, Caccitolo JA, Pearson PJ, et al. New approaches to prev-ention and treatment of radial artery graft vasospasm. Circulation, 1998, 98(19 Suppl): 1115-1122.
8. 陶登顺, 汪曾炜, 王辉山, 等.内皮型一氧化氮合酶基因转染防治移植静脉再狭窄的实验研究.中华外科杂志, 2005, 43(5): 657-658.
9. 陶登顺, 王辉山.冠状动脉旁路移植术后血管桥再狭窄的机制及防治现状.心脏杂志, 2006, 18(5): 585-587.
10. 陶登顺, 王辉山, 汪曾炜, 等.兔颈静脉动脉化后血管的重塑机制.第四军医大学学报, 2006, 25(14): 1456-1458.
11. Baskett RJ, Cafferty FH, Powell SJ, et al. Total artenal revasculariza-tion is safe: Multicenter ten-year analysis of 71, 470 coronary procedures. Ann Thorac Surg, 2006, 81(4): 1243-1248.
12. Tranbaugh RF, Dimitrova KR, Friedmann P, et al. Radial artery conduits improve long-term survival after coronary artery bypass grafting. Ann Thorac Surg, 2010, 90(4): 1165-1172.
13. Hortmann HC, Oliveira HG, Rabello RR, et al. Comparison of patency between radial artery and saphenous vein in a coronary artery bypass grafting postoperative with return of the symptoms. Rev Bras Cir Cardiovasc, 2010, 25(2): 218-223.
14. Ivana P, Dusko N, Miodrag P, et al. Radial artery vs saphenous vein graft used as the second conduit for surgical myocardial revascularization: long-term clinical follow-up. J Cardiothorac Surg, 2015, 10: 127-133.
15. Won-Chol C, Joon BK, Sung HJ, et al. Revascularization of the left anterior descending artery area using a single left internal thoracic artery: Auto-Y composite graftingor sequential bypassing. J Thorac Cardiovasc Surg, 2011, 142(6): 1464-1468．.
16. 万峰, 王京生, 主编.现代冠心病外科治疗学.北京:中国协和医科大学出版社, 2003. 28-38．.
17. Lemma M, Gelpi G, Mangini A, et al. Myocardial revascularization with multiple arterial grafts: comparison between the radial artery. Ann Thorac Surg, 2001, 71(6): 1969-1973.
18. William R, Burfeind JR, Donald D, et al. Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial. Circulation, 2004, 110(1): 1127-1135.
19. Calafior AM, Di Giammarco G, Luciani N, et al. Composite artrial conduits for a wider artrial myocardial rvascularization. Ann Thorac Surg, 1994, 58(1): 185-190.
20. Gaudino M, Di Mauro M, Iacò AL, et al. Immediat flow reserve of Y thoracic artry grafts' an intraoperative flow metric study. Thorac Cardiovasc Surg, 2003, 126(4): 1076-1079.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Left Ventrical Total Artery Revascularization with "T"-type Anasto-mosis of Left Internal Mammary Artery and Radial Artery on Pump

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