Supraclavicular control of patent internal thoracic artery graft flow during aortic valve replacement
The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump fail...
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Published in | The Annals of thoracic surgery Vol. 75; no. 5; pp. 1422 - 1428 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.05.2003
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Abstract | The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump failure.
A total of 43 patients with a patent LITA graft underwent AVR. The patients were divided into the two groups. Group 1 included 19 patients who underwent AVR with deep hypothermia (20°C) without LITA clamping. Group 2 included 24 patients in whom LITA flow was controlled through supraclavicular occlusion and AVR performed with moderate hypothermia (28°C).
Average cardiopulmonary bypass time (CPB) time was 118.79 ± 20.36 minutes in group 1 and 102.67 ± 9.66 minutes in group 2 (
p = 0.006). Average cross-clamp time was 53.79 ± 7.26 minutes in group 1 and 49.63 ± 6.7 minutes in group 2 (
p = 0.022). Inotropic support was required in 12 patients in group 1 and 4 patients in group 2 (
p = 0.002). Average intensive care unit stay was 4.68 ± 2.24 days in group 1 and 2.29 ± 0.46 days in group 2 (
p < 0.001). Average hospital stay was 11.84 ± 2.91 days in group 1 and 8.04 ± 2.38 days in group 2 (
p < 0.001). Mortality due to myocardial failure developed in 4 patients in group 1 but in none of the patients in group 2 (
p = 0.02).
Proximal control of LITA flow by extrathoracic supraclavicular occlusion reduces the incidence of myocardial failure due to nonhomogenous cardioplegia delivery to the anterior wall of the heart, resulting in improved myocardial protection and the elimination of the need for deep hypothermia. |
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AbstractList | BACKGROUNDThe mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump failure.METHODSA total of 43 patients with a patent LITA graft underwent AVR. The patients were divided into the two groups. Group 1 included 19 patients who underwent AVR with deep hypothermia (20 degrees C) without LITA clamping. Group 2 included 24 patients in whom LITA flow was controlled through supraclavicular occlusion and AVR performed with moderate hypothermia (28 degrees C).RESULTSAverage cardiopulmonary bypass time (CPB) time was 118.79 +/- 20.36 minutes in group 1 and 102.67 +/- 9.66 minutes in group 2 (p = 0.006). Average cross-clamp time was 53.79 +/- 7.26 minutes in group 1 and 49.63 +/- 6.7 minutes in group 2 (p = 0.022). Inotropic support was required in 12 patients in group 1 and 4 patients in group 2 (p = 0.002). Average intensive care unit stay was 4.68 +/- 2.24 days in group 1 and 2.29 +/- 0.46 days in group 2 (p < 0.001). Average hospital stay was 11.84 +/- 2.91 days in group 1 and 8.04 +/- 2.38 days in group 2 (p < 0.001). Mortality due to myocardial failure developed in 4 patients in group 1 but in none of the patients in group 2 (p = 0.02).CONCLUSIONSProximal control of LITA flow by extrathoracic supraclavicular occlusion reduces the incidence of myocardial failure due to nonhomogenous cardioplegia delivery to the anterior wall of the heart, resulting in improved myocardial protection and the elimination of the need for deep hypothermia. The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump failure. A total of 43 patients with a patent LITA graft underwent AVR. The patients were divided into the two groups. Group 1 included 19 patients who underwent AVR with deep hypothermia (20 degrees C) without LITA clamping. Group 2 included 24 patients in whom LITA flow was controlled through supraclavicular occlusion and AVR performed with moderate hypothermia (28 degrees C). Average cardiopulmonary bypass time (CPB) time was 118.79 +/- 20.36 minutes in group 1 and 102.67 +/- 9.66 minutes in group 2 (p = 0.006). Average cross-clamp time was 53.79 +/- 7.26 minutes in group 1 and 49.63 +/- 6.7 minutes in group 2 (p = 0.022). Inotropic support was required in 12 patients in group 1 and 4 patients in group 2 (p = 0.002). Average intensive care unit stay was 4.68 +/- 2.24 days in group 1 and 2.29 +/- 0.46 days in group 2 (p < 0.001). Average hospital stay was 11.84 +/- 2.91 days in group 1 and 8.04 +/- 2.38 days in group 2 (p < 0.001). Mortality due to myocardial failure developed in 4 patients in group 1 but in none of the patients in group 2 (p = 0.02). Proximal control of LITA flow by extrathoracic supraclavicular occlusion reduces the incidence of myocardial failure due to nonhomogenous cardioplegia delivery to the anterior wall of the heart, resulting in improved myocardial protection and the elimination of the need for deep hypothermia. The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery (LITA) is significant. The risk of LITA injury and inadequate myocardial preservation during the cross-clamp period may cause myocardial pump failure. A total of 43 patients with a patent LITA graft underwent AVR. The patients were divided into the two groups. Group 1 included 19 patients who underwent AVR with deep hypothermia (20°C) without LITA clamping. Group 2 included 24 patients in whom LITA flow was controlled through supraclavicular occlusion and AVR performed with moderate hypothermia (28°C). Average cardiopulmonary bypass time (CPB) time was 118.79 ± 20.36 minutes in group 1 and 102.67 ± 9.66 minutes in group 2 ( p = 0.006). Average cross-clamp time was 53.79 ± 7.26 minutes in group 1 and 49.63 ± 6.7 minutes in group 2 ( p = 0.022). Inotropic support was required in 12 patients in group 1 and 4 patients in group 2 ( p = 0.002). Average intensive care unit stay was 4.68 ± 2.24 days in group 1 and 2.29 ± 0.46 days in group 2 ( p < 0.001). Average hospital stay was 11.84 ± 2.91 days in group 1 and 8.04 ± 2.38 days in group 2 ( p < 0.001). Mortality due to myocardial failure developed in 4 patients in group 1 but in none of the patients in group 2 ( p = 0.02). Proximal control of LITA flow by extrathoracic supraclavicular occlusion reduces the incidence of myocardial failure due to nonhomogenous cardioplegia delivery to the anterior wall of the heart, resulting in improved myocardial protection and the elimination of the need for deep hypothermia. |
Author | Sanisoglu, S.Yavuz Özal, Ertuğrul Cingöz, Faruk Öz, Bilgehan Savaş Tatar, Harun Yildirim, Vedat Kuralay, Erkan Arslan, Mehmet Küçükarslan, Nezihi Günay, Celalettin Demırkiliç, Ufuk |
Author_xml | – sequence: 1 givenname: Erkan surname: Kuralay fullname: Kuralay, Erkan email: ekural@gata.edu.tr organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 2 givenname: Faruk surname: Cingöz fullname: Cingöz, Faruk organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 3 givenname: Celalettin surname: Günay fullname: Günay, Celalettin organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 4 givenname: Bilgehan Savaş surname: Öz fullname: Öz, Bilgehan Savaş organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 5 givenname: Nezihi surname: Küçükarslan fullname: Küçükarslan, Nezihi organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 6 givenname: Vedat surname: Yildirim fullname: Yildirim, Vedat organization: Anesthesiology, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 7 givenname: S.Yavuz surname: Sanisoglu fullname: Sanisoglu, S.Yavuz organization: Biostatistics, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 8 givenname: Ertuğrul surname: Özal fullname: Özal, Ertuğrul organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 9 givenname: Ufuk surname: Demırkiliç fullname: Demırkiliç, Ufuk organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 10 givenname: Mehmet surname: Arslan fullname: Arslan, Mehmet organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey – sequence: 11 givenname: Harun surname: Tatar fullname: Tatar, Harun organization: Departments of Cardiovascular Surgery, Gülhane Military Medical Academy, Etlık, Ankara, Turkey |
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CitedBy_id | crossref_primary_10_1093_ejcts_ezr212 crossref_primary_10_1016_j_athoracsur_2003_09_064 crossref_primary_10_1093_ejcts_ezs178 crossref_primary_10_1080_08998280_2011_11928673 crossref_primary_10_1186_s13019_015_0383_x crossref_primary_10_1007_BF02662470 crossref_primary_10_1016_j_athoracsur_2004_09_003 |
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ident: 10.1016/S0003-4975(02)04989-5_BIB11 article-title: Aortic valve surgery after previous coronary artery bypass grafting with functioning internal mammary artery grafts publication-title: Ann Thorac Surg doi: 10.1016/S0003-4975(01)03456-7 contributor: fullname: Byrne – volume: 107 start-page: 675 year: 1994 ident: 10.1016/S0003-4975(02)04989-5_BIB13 article-title: Influence of arterial coronary bypass grafts on the mortality in coronary reoperations publication-title: J Thorac Cardiovasc Surg doi: 10.1016/S0022-5223(94)70322-1 contributor: fullname: Lytle |
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Snippet | The mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic artery... BACKGROUNDThe mortality and morbidity of aortic valve replacement (AVR) after prior coronary artery bypass surgery (CABG) with patent left internal thoracic... |
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SubjectTerms | Aged Aged, 80 and over Aorta Aortic Valve - surgery Aortic Valve Insufficiency - physiopathology Aortic Valve Insufficiency - surgery Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Cardiopulmonary Bypass Constriction Coronary Artery Bypass Female Heart Arrest, Induced Heart Valve Prosthesis Implantation - adverse effects Humans Hypothermia, Induced Male Mammary Arteries - injuries Mammary Arteries - transplantation Middle Aged Myocardial Infarction - etiology Regional Blood Flow Vascular Patency |
Title | Supraclavicular control of patent internal thoracic artery graft flow during aortic valve replacement |
URI | https://dx.doi.org/10.1016/S0003-4975(02)04989-5 https://www.ncbi.nlm.nih.gov/pubmed/12735556 https://search.proquest.com/docview/73254461 |
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