scholarly journals Rheolytic effects of left main mid-shaft/distal stenting: a computational flow dynamic analysis

2018 ◽  
Vol 12 (6) ◽  
pp. 161-168 ◽  
Author(s):  
Gianluca Rigatelli ◽  
Marco Zuin ◽  
Fabio Dell’Avvocata ◽  
Thach Nguyen
Keyword(s):  
Coronary Artery ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Quantitative Coronary Angiography ◽  
Culprit Lesion ◽  
Left Main ◽  
Coronary Bypass Graft ◽  
The Mean ◽  
Real Practice ◽  
Distal Disease

Background The aim of this study was to evaluate the rheolytic effects of stenting a mid-shaft/distal left main coronary artery (LMCA) lesion with and without ostial coverage. Stenting of the LMCA has emerged as a valid alternative in place of traditional coronary bypass graft surgery. However, in case of mid-shaft/distal lesion, there is no consensus regarding the extension of the strut coverage up to the ostium or to stent only the culprit lesion. Methods We reconstructed a left main-left descending coronary artery (LM-LCA)-left circumflex (LCX) bifurcation after analysing 100 consecutive patients (mean age 71.4 ± 9.3, 49 males) with LM mid-shaft/distal disease. The mean diameter of proximal LM, left anterior descending (LAD) and LCX, evaluated with quantitative coronary angiography (QCA) was 4.62 ± 0.86 mm, 3.31 ± 0.92 mm, and 2.74 ± 0.93 mm, respectively. For the stent simulation, a third-generation, everolimus-eluting stent was virtually reconstructed. Results After virtual stenting, the net area averaged wall shear stress (WSS) of the model and the WSS at the LCA-LCX bifurcation resulted higher when the stent covered the culprit mid-shaft lesion only compared with the extension of the stent covering the ostium (3.68 versus 2.06 Pa, p = 0.01 and 3.97 versus 1.98 Pa, p < 0.001, respectively. Similarly, the static pressure and the Reynolds number were significantly higher after stent implantation covering up the ostium. At the ostium, the flow resulted more laminar when stenting only the mid-shaft lesion than including the ostium. Conclusions Although these findings cannot be translated directly into real practice our brief study suggests that stenting lesion 1:1 or extending the stent to cover the LM ostium impacts differently the rheolytic properties of LMCA bifurcation with potential insights for restenosis or thrombosis.

scholarly journals Stenting of Anomalous Left Main Coronary Artery Stenosis in an Adult with a Retroaortic Course

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Lanjewar Charan ◽  
Santosh Shiradkar ◽  
P. G. Kerkar ◽  
Agrawal Ashish
Keyword(s):  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Interesting Case ◽  
Artery Stenosis ◽  
Left Main ◽  
Aortic Sinus ◽  
Coronary Bypass Graft

Coronary bypass graft has been the conventional treatment of choice in anomalous left man coronary artery stenosis. We are reporting an interesting case with anomalous left main coronary artery originating from right aortic sinus having retroaortic course complicated by significant atherosclerotic narrowing of the vessel and its percutaneous management.

scholarly journals Comparative Evaluation of ‘Will Bleed, Papworth, Track and Trust’ Bleeding Risk Scores in Diabetic Isolated Coronary Bypass Graft Surgery Patients and Laying the Foundations for Optimum Risk Score for Bleeding After Coronary Bypass Graft Surgery

2021 ◽  
Author(s):  
engin akgül ◽  
Abdulkerim Ozhan
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Risk Score ◽  
Blood Product ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Scoring Systems ◽  
Diabetic Patients ◽  
Coronary Bypass Graft

Background: One of the most undesired complications after open heart operations is bleeding. In our study, we set ourselves two different goals: examining ‘Papworth, Will-Bleed, Track and Trust’ bleeding scoring systems to determine the most predictive one among diabetic patients undergoing isolated coronary bypass surgery, and determining the variables that should be included in the new scoring systems to be established for this patient group. Methods: The files of 297 diabetic patients who underwent isolated coronary artery bypass operation between 2017-2019 were retrospectively reviewed. Patients who underwent emergency surgery with a beating heart, those with reoperated open hart surgery, those with ticagrelor use, and those who died within the first 24 postoperative hours were excluded from the study. Drainage from the thorax and mediastinal tubes and blood product transfusions to the patients within the first 24 hours were noted and analyzed according to scoring systems. Results: Scoring systems are evaluated based on ‘European Multicenter Study on Coronary Artery Bypass Grafting Bleeding Severity (E-CABG)’. In this study including diabetic patients only, Papworth was better predictive of E-CABG bleeding Grade 2-3. We found that Will-Bleed, Track, Trust, the other scoring systems we examined had discriminatory value in terms of E-CABG bleeding Grade 2-3 in our study group. Among the parameters in the scoring systems, we concluded that gender, preoperative hemoglobin (or hematocrit) value, preoperative platelet count, use of antiplatelets until less than five days prior to the operation, and preoperative creatinine (or eGFR) values should be included in the scoring system we aim to establish in the future, called the “Optimum Risk Score for Bleeding (ORS).” Conclusion: Considering the possible risks of bleeding and blood product transfusion, scoring systems that will provide accurate results for patient blood management will be lifesaving and increase the cost-effectiveness of the treatment.

scholarly journals Coronary-Coronary bypass graft as a safe and an alternative technique for revascularization of coronary arteries

2020 ◽  
Author(s):  
Reda Bzikha ◽  
Gautier Charles Henri
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Respiratory Morbidity ◽  
Artery Bypass Graft ◽  
Coronary Bypass Graft ◽  
Conventional Coronary Artery Bypass

Coronary–coronary bypass graft was first performed by Rowland and Grooters. This technique can be performed between two segments of the same coronary artery using saphenous vein grafts or free arterial grafts in on/off-pump coronary artery bypass grafting, also can be an alternative safe technique in some cases as calcified ascending aorta, porcelain aorta and insufficient graft length. The coronarycoronary bypass graft can provide nearly the same flow rate as conventional coronary artery bypass graft, another advantage this technique is that we can use to decrease sternal and respiratory morbidity. we performed this technique to a 55-year-old woman to whom coronary angiography showed critical three-vessel disease, using a free segment of right internal mammary artery, combined to conventional coronary artery bypass graft. The postoperative course was uneventful with the absence of ischemic lesions and the grafts were patent at 6 months after procedure.

scholarly journals Subclavian-coronary bypass graft re-operation according to the MICS technique in a patient with angina relapse

2019 ◽  
pp. 94-96
Author(s):  
I. Yu. Sigaev ◽  
M. A. Keren ◽  
A. V. Kazaryan ◽  
I. V. Pilipenko ◽  
G. G. Getsadze
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Patient Comfort ◽  
Successful Implementation ◽  
Coronary Bypass Graft ◽  
Selection Of

Coronary artery bypass graft (CABG) using short-scar incision (without median sternotomy) allows minimizing the invasiveness of the intervention, reducing the risks of postoperative complications, and also ensuring patient comfort and quick social and physical rehabilitation. The successful implementation of such operations is due not only to surgical skills and the integration of technological achievements into practice, but also to the appropriate selection of patients. The article presents a clinical case of successful re-operation of the subclavian-coronary artery bypass grafting on a beating heart using antero-lateral thoracotomy approach in a patient with angina relapse after CABG.

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