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Multiple Grafting with Single Left Internal Mammary Artery as T-Graft with Itself
The Thoracic and Cardiovascular Surgeon ( IF 1.5 ) Pub Date : 2021-09-14 , DOI: 10.1055/s-0041-1731758
Christian Jörg Rustenbach 1 , Ilija Djordjevic 1 , Stephen Gerfer 1 , Borko Ivanov 1 , Christopher Gaisendrees 1 , Kaveh Eghbalzadeh 1 , Thorsten Wahlers 1
Affiliation  

Background Revascularization strategies might be limited in patients with lack of sufficient bypass graft material and increased risk of wound healing disturbances. In this regard, we present first results of patients treated with left internal mammary artery (LIMA) as T-graft with itself due to left-sided double-vessel disease, elevated risk of wound healing infection, and lack of graft material.

Methods Eighteen patients were retrospectively analyzed in this study. All patients received LIMA grafting, and additional T-graft with itself during off-pump coronary artery bypass surgery. The investigation was focused on intraoperative and postoperative outcomes.

Results LIMA-LIMA T-graft was performed in a total of 18 patients. Mean Fowler score accounted for 18.2 ± 2.9. Severe vein varicosis was present in 9 patients, and 38.9% of patients had lacking venous graft material due to prior vein stripping. A total of 2.5 ± 0.5 distal anastomoses were performed. Mean flow of LIMA—left anterior descending anastomosis was 41.72 ± 12.11 mL/min with a mean pulsatility index (PI) of 1.01 ± 0.21. Mean flow of subsequent T-graft accounted for 26.31 ± 4.22 mL/min with a mean PI of 1.59 ± 0.47. Median hospital stay was 7(6.75;8) days. No incidence of postoperative wound healing disorders was observed and all patients were discharged off hospital.

Conclusions LIMA as T-graft with itself to treat left-sided double-vessel disease is feasible and safe in patients with missing bypass graft material and increased risk of deep sternal wound infection. Further prospective studies are necessary to confirm our results.



中文翻译:

单根左内乳动脉多路移植作为 T 型移植物

背景 在缺乏足够的旁路移植材料和增加伤口愈合障碍风险的患者中,血运重建策略可能受到限制。在这方面,我们展示了由于左侧双血管疾病、伤口愈合感染风险升高和缺乏移植材料而接受左乳内动脉 (LIMA) 作为自身 T 型移植物治疗的患者的初步结果。

方法 对18例患者进行回顾性分析。在非体外循环冠状动脉搭桥手术期间,所有患者都接受了 LIMA 移植,以及额外的 T 型移植。调查的重点是术中和术后结果。

结果 LIMA-LIMA T-graft 共在 18 名患者中进行。平均 Fowler 得分占 18.2 ± 2.9。9 名患者出现严重静脉曲张,38.9% 的患者因先前的静脉剥离而缺乏静脉移植材料。总共进行了 2.5 ± 0.5 次远端吻合。LIMA-左前降吻合的平均流量为 41.72 ± 12.11 mL/min,平均搏动指数 (PI) 为 1.01 ± 0.21。随后的 T 移植物的平均流量为 26.31 ± 4.22 mL/min,平均 PI 为 1.59 ± 0.47。中位住院时间为 7(6.75;8) 天。未观察到术后伤口愈合障碍发生率,所有患者均出院。

结论 LIMA作为T形移植物自身治疗左侧双血管病变对于旁路移植材料缺失、胸骨深部伤口感染风险增加的患者是可行且安全的。需要进一步的前瞻性研究来证实我们的结果。

更新日期:2021-09-15
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