Hidetsugu Ogasawara

Serial change in the atrial transport function after the radial incision approach

BACKGROUND The left atrial transport function recovers slowly over several months after the maze procedure (Maze), but remains at a low level even during the long-term postoperative period. Because the Maze leaves an insufficient left atrial transport function, patients may still be prone to thromboembolism after the Maze. The radial incision approach (Radial) has been shown to preserve greater atrial transport function than does the Maze in the early postoperative period. METHODS To examine the serial change in the atrial transport function after the Radial, out of 32 patients who underwent the Radial, 15 patients were assessed by transthoracic Doppler echocardiography 1, 3, 6, and 12 months after surgery. The atrial filling fraction and peak A/E velocity ratio were determined from the flow-velocity spectra across the mitral and tricuspid valves. The incidence of thromboembolic events was examined in 21 patients who were followed for more than 3 months after the Radial. The data were compared with data obtained from 13 patients after (41 +/- 6 months) the Maze III procedure. RESULTS The left atrial transport function after the Radial increased within 3 months to a significantly greater level than did that after the Maze in the longterm. The atrial filling fraction was 28.2% +/- 7.9% at 3 months after the Radial and 15.1% +/- 4.0% at 41 months after the Maze (p < 0.01). The peak A/E ratio was 0.52 +/- 0.18 at 3 months after the Radial and 0.25 +/- 0.07 at 41 months after the Maze (p < 0.01). This increased atrial transport function was maintained for an extended period after the Radial. There were no thromboembolic events in any of the patients after the Radial or Maze, irrespective of postoperative anticoagulant therapy. CONCLUSIONS The Radial approach prevents thromboembolism by restoring sufficient atrial transport function more effectively and faster than does the Maze.

Impact of sequential grafting of the internal thoracic or right gastroepiploic arteries on multiple coronary revascularization.

OBJECTIVE The aim of the study is to clarify the efficacy of the sequential anastomotic technique of the arterial conduits for multiple coronary revascularization. BACKGROUND The internal thoracic artery (ITA) is now widely accepted as a durable conduit for myocardial revascularization. The right gastroepiploic artery (GEA) has been developed as a third in situ arterial graft with an outcome similar to that of the ITA. MATERIAL AND METHOD One hundred and forty five consecutive patients (116 male, 29 female, mean age 60.4yr) who received sequential grafting of either the ITA or GEA or both were retrospectively analysed. RESULTS Sequential anastomoses were performed in 121 in situ left ITAs, 36 in situ GEAs and 12 composite right ITAs. No in situ right ITA was anastomosed sequentially. Two to six vessels (mean 3.8) were revascularized for each patient. Of the total 543 bypassed vessels, 432 (79.6%) were reconstructed with the arterial grafts. In 85 patients with quadruple bypass or more, the arterial grafts were able to reconstruct 266 out of 360 (74.0%) target vessels. Seventy one patients (49.0%) were revascularized without venous grafts. The arterial grafts could revascularize 293 out of 310 vessels (94.5%) in the LAD approximately Diagonal region, 83 out of 113 (73.4%) in the distal RCA or Cx region. There were no cardiac events responsible for the arterial grafts in the follow up period. CONCLUSION In light of our experience, multiple revascularization with in situ arterial sequential grafts is feasible. Aggressive application of this technique provides patients requiring multiple coronary revascularization with favorable long-term results.

Coronary bypass surgery using the internal thoracic artery after reconstruction of occluded subclavian artery

We present two cases with an occluded left subclavian artery requiring coronary artery bypass grafting. A preoperative angiogram confirmed that the subclavian artery, including the internal thoracic artery distal from the occlusion, was thoroughly intact, in both cases. Immediately after reconstructing the subclavian artery using an aortoaxillary bypass with an 8 mm ring-reinforced polytetrafluoroethylene graft, each patient underwent double coronary artery bypass grafting using the affected left internal thoracic artery with either the right internal thoracic artery or a saphenous vein in the same anesthetic setting. Symptomatic relief was excellent. In both cases, a postoperative angiographic study showed good function of the left internal thoracic artery graft supplying blood to the coronary artery through the aortoaxillary bypass graft.

Combined non-cardiac operations with minimally invasive direct coronary artery bypass grafting

We report two cases in which Minimally invasive direct coronary artery bypass grafting was followed by other non-cardiac operations in the same operative setting. A left internal thoracic artery-to-left anterior descending artery anastomosis was constructed through a left anterior thoracotomy in both patients. Immediately after Minimally invasive direct coronary artery bypass grafting, one patient underwent a pancreatoduodenectomy for a biliary duct carcinoma and the other patient received a prosthetic graft replacement for an abdominal aortic aneurysm. Minimally invasive direct coronary artery bypass grafting is advantageous in patients with significant coronary artery disease who have to undergo other non-cardiac surgeries.