Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting.
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BACKGROUND: The aim of this study was to evaluate the performance of bilateral internal mammary artery (BIMA) grafts in isolated CABG. METHODS AND RESULTS: Beginning in April 1985, elective primary multiple CABG for multivessel disease was performed in 1131 patients. The early and late results of 688 patients who received single internal mammary artery (SIMA) grafts and 443 patients who received BIMA grafts were compared (median follow-up, 6.15 years). Hospital mortality was not significantly different in the SIMA (0.9%) and BIMA (0.9%) groups. Graft patency was 97.3% in the BIMA group and 94.3% in the SIMA group (P<0.0001). The 7-year repeated CABG-free rate was significantly higher in the BIMA group (P=0.026). The 7-year new myocardial infarction-free rate in all patients tended to be higher in the BIMA group (P=0.06). The hazard ratio for all death or repeated CABG in patients with ejection fractions >0.4 and age <71 years was lower in the BIMA group (P=0.0499). CONCLUSIONS: Our data suggest that the use of BIMA grafts in patients with in situ coronary artery anastomoses achieves a significantly higher repeated CABG-free rate in all patients compared with the use of SIMA. (+info)
Concomitant cholecystectomy and coronary artery bypass.
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INTRODUCTION AND METHODS: Cholelithiasis is a common disorder which may be present with coronary artery disease. Concomitant cholecystectomy and coronary artery bypass grafting (CABG) was performed in selected patients and retrospective study was performed to verify the safety of the concomitant surgery. RESULTS: A total of 55 patients (41 males and 14 females, mean age 64.6 8.7 years) underwent concomitant cholecystectomy and CABG between 1992 and 2001 at the Shin-Tokyo Hospital Group. Exclusion from concomitant surgery was choledocholithiasis and/or acute cholecystitis. Cholecystectomy was performed via an upper abdominal incision extending the mid-sternal incision. In 48 patients (87.3%), the gastroepiploic artery (GEA) was used for coronary revascularization. The mean number of bypass grafts was 3.6 1.2. The mean operative time, intubation period, ICU stay, and postoperative hospital stay were 376 minutes, 15.6 hours, 3.9 days, and 23.0 days, respectively. Postoperative feeding was resumed 1 day after extubation. No intra-abdominal complications, delays in feeding, abdominal wound complications or postoperative bowel obstruction were observed. CONCLUSIONS: Concomitant surgery of cholecystectomy and CABG did not increase the postoperative complications, and it is a feasible procedure of choice. (+info)
Spontaneous rupture of a left gastroepiploic artery aneurysm.
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Gastroepiploic aneurysms are extremely rare. They occur mainly in elderly men and in 90% of cases are ruptured at presentation. Visceral aneurysms though rare should be borne in mind in cases of unexplained haemorrhagic shock. We present a case of a 79-year-old man who presented with abdominal pain, hypotension and anaemia but no obvious source of bleeding. He had undergone a prior aorto-bifemoral graft. The patient refused an operation and died the following day. (+info)
Existence of alpha-adrenoceptor subtypes in isolated human gastroepiploic and omental arteries.
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Establishing the existence of alpha-adrenoceptor subtypes in isolated human gastroepiploic and omental arteries was the goal of the present study. Functional vascular reactivity of selective alpha(1)- and alpha(2)-adrenoceptor agonists and antagonists was studied, using a cannula inserting technique. Intraluminal administration of norepinephrine (NE), phenylephrine (PE) or BHT-933 caused a vasoconstrictive response in a dose-related manner. The relative potencies of the 3 agonists were almost the same in both arteries. NE-induced vasoconstrictions were significantly antagonized by either prazosin or rauwolscine. PE-induced responses were strongly inhibited by prazosin. BHT-933-induced constrictions were inhibited by rauwolscine. These results indicate that both alpha(1)- and alpha(2)-adrenoceptors exist in the human gastroepiploic and omental arteries. (+info)
Functional alpha1-adrenergic receptor subtypes in human right gastroepiploic artery.
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AIM: To study the functional alpha1-adrenergic receptor (alpha1-AR) subtypes in human right gastroepiploic artery (RGA). METHODS: The effects of alpha2-AR, alpha1-AR, and alpha1-AR subtype selective antagonists on norepinephrine (NE)-induced vasoconstriction in isolated human RGA were observed by contractile function experiment. RESULTS: Cumulative concentration-response curves for NE were competitively antagonized in RGA by alpha2-AR selective antagonist yohimbine (pA2 6.82+/-0.28, slope 1.12+/-0.40),alpha1-AR selective antagonist prazosin (pA2 9.77+/-0.22, slope 0.90+/-0.22),alpha1A-AR selective antagonists RS17053 (pA2 8.42+/-0.20, slope 0.93+/-0.20) and 5-MU (pA2 8.42+/-0.22, slope 0.88+/-0.18),alpha1D-AR selective antagonist BMY7378 (pA2 6.84+/-0.32, slope 1.05+/-0.17), and alpha1A-,alpha1B-AR selective antagonist WB4101 (pA2 8.88+/-0.20, slope 1.15+/-0.16). The correlation coefficients between these pA2 values of alpha1-AR selective antagonists with pKi values of which obtained from alpha1A-, alpha1B- and alpha1D-AR cloned cells are 0.95, 0.82, and 0.42. After the vessels were pretreated by chlorethylclonidine (CEC), an alpha1B- and alpha1D-AR irreversible alkylating agent, the pD2 values were changed from 5.9+/-0.5 to 5.6+/-0.6 and the maximal contraction was changed from (8.9+/-3.2) g to (8.0+/-3.2) g, respectively. The difference was not significant. CONCLUSION: In human RGA, the contraction response is mainly mediated by alpha1-AR, of which alpha1A-AR plays an important role, whereas alpha1B- and alpha1D-AR are not involved in the contraction response. (+info)
Abdominal surgery following coronary artery bypass grafting using an in situ right gastroepiploic artery graft.
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OBJECTIVE: The usefulness of the gastroepiploic artery (GEA) as arterial grafts in coronary artery bypass grafting (CABG) has been studied extensively. We report our experience performing abdominal surgery after CABG using in-situ GEA. METHODS: The subjects were eight patients who underwent abdominal surgery after CABG with an in situ GEA graft. The surgical indications were malignant tumors in five patients, an infrarenal abdominal aortic aneurysm in two patients and a diaphragmatic hernia in one patient. The interval from the CABG to the abdominal surgery ranged from 3 to 19 months. RESULTS: Operations included distal gastrectomy in two cases, total gastrectomy in one case, local excision of the stomach in one case, and excision of the transverse colon in one case. Aorto-biiliac artery bypass was performed in two cases, and the diaphragmatic hernia was reconstructed using standard techniques. When the skeletonization method has been used to harvest the GEA, GEA grafts were easily identified during a laparotomy, and the abdominal procedure was performed using routine methods. One patient died of cancer, and the other patients are alive 1 year 2 months to 4 years 5 months after surgery. No patient reported recurrence of angina. CONCLUSION: The risk of abdominal reoperations should be considered when using the in situ right GEA for CABG. We recommend the skeletonization method for GEA harvest to decrease the difficulty during second abdominal operations. (+info)
Gastric cancer occurred after coronary artery bypass grafting using the right gastroepiploic artery.
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We recently encountered a rare case where gastric cancer developed in the long-term postoperative stage after coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) and distal partial gastrectomy was performed to treat the cancer. The patient was a 64-year-old man. In November 2001, he underwent three-vessel CABG, involving bypassing between the right coronary artery (RCA) and the RGEA, to treat an old myocardial infarction. In May 2003, he was admitted to our hospital because of exacerbation of diabetes mellitus and anemia. Gastric endoscopy revealed gastric cancer affecting the pylorus. Preoperative abdominal angiography showed the RGEA graft remained well patent. In June 2003, he underwent distal partial gastrectomy and regional lymph node dissection. Because the RGEA had been freed adequately to the point of bifurcation of the gastroduodenal artery during the previous CABG, the RGEA graft was preserved during distal partial gastrectomy. When the RGEA is used for CABG, it seems advisable to free the RGEA adequately to a point of bifurcation of the gastroduodenal artery. If done so, regional lymph node dissection around the RGEA is easier to perform when gastric cancer has occurred in these cases, eventually reducing the risk for injury of the graft. Following CABG with the RGEA, it seems essential to perform periodical checks for gastric cancer to facilitate early detection of gastric cancer. The necessity of close follow-up of these cases is endorsed by the fact that healing of gastric cancer by endoscopic mucosal resection (EMR) is highly probable if the cancer is detected at early stages. (+info)
Neurogenic double-peaked vasoconstriction of human gastroepiploic artery is mediated by both alpha1- and alpha2-adrenoceptors.
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1. The contribution of postjunctional P2X receptors and subtypes of alpha-adrenoceptors to vasoconstrictor responses following periarterial electrical nerve stimulation (PNS, 30 s trains of pulses at a frequency of 2, 4 or 8 Hz) was investigated in human gastroepiploic arteries. 2. The vasoconstrictor response to PNS at a stimulation of 4 or 8 Hz was a two-peaked response, whereas at a frequency of 2 Hz it appeared only as a late peak. All vasoconstrictions evoked by PNS were abolished by phentolamine, a nonselective alpha-adrenoceptor inhibitor, but not by alpha,beta-methylene ATP, a P2X receptor-desensitizing agent. 3. The early peak to PNS at 4 or 8 Hz was abolished by prazosin, an alpha1-adrenoceptor antagonist, while the late one still remained, although it was markedly inhibited. The responses remaining after prazosin were blocked by rauwolscine. The vasoconstrictor response to PNS at 2 Hz was not affected by prazosin (0.1 microM), but was abolished by rauwolscine (0.1 microM), an alpha2-adrenoceptor antagonist. 4. OPC-28326 (10 microM), a newly developed vasodilator, which preferentially exerts its antagonistic actions on the alpha2B- and alpha2C-adrenoceptors, significantly reduced the noradrenaline-induced vasoconstriction in the absence or presence of prazosin. OPC-28326 had a greater inhibitory effect on the late peak evoked by PNS than the early one. The neurogenic responses remaining after OPC-28326 were abolished by prazosin. 5. The present results suggest that sympathetic vasoconstriction of the human gastroepiploic artery is mediated by both alpha1- and alpha2-adrenoceptors postjunctionally, but not by P2X receptors. The alpha2-adrenoceptors may be preferentially activated at a low frequency of stimulation, which induces a constriction more slowly than that by alpha1-adrenoceptors. The existence of alpha2-adrenoceptors may cause an enhancement of alpha1-adrenoceptor-induced responses. (+info)