Delayed Pleuropulmonary Complications following Coronary Artery Revascularization with the Internal Mammary Artery

A 55-year-old man developed severe mitral regurgitation with persistent fungal infective endocarditis 8 months after coronary artery bypass grafting with a left internal mammary artery and 2 saphenous veins, as well as mitral valve repair with a prosthetic ring. Echocardiography demonstrated severe mitral regurgitation and a valvular vegetation. Computed tomography coronary arteriography indicated that all grafts were patent and located intimately close to the sternum. Median resternotomy was not attempted due to the risk of injury to the bypass grafts, and therefore, a right anterolateral thoracotomy approach was utilized. Mitral valve replacement was performed with the patient under deep hypothermia and ventricular fibrillation without aortic cross-clamping. The patient`s postoperative course was uneventful. Thus, right anterolateral thoracotomy may be a superior approach to mitral valve surgery in patients who have undergone prior coronary artery bypass grafting.

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Survival benefit from a second arterial conduit to the circumflex circulation persists in elderly after coronary artery bypass surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997077 ◽

2021 ◽

pp. 021849232199707

Author(s):

Suvitesh Luthra ◽

Miguel M Leiva-Juárez ◽

Pietro G Malvindi ◽

John S Billing ◽

Sunil K Ohri

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Survival Benefit ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Arterial Graft ◽

Arterial Conduit ◽

Internal Mammary

Background This retrospective propensity matched study investigated the impact of age on the survival benefit from a second arterial conduit to the left-sided circulation. Methods Data for isolated coronary artery bypass surgery were collected from October 2004 to March 2014. All patients with an internal mammary artery graft to left anterior descending artery and additional arterial or venous graft to the circumflex circulation were included. Propensity matching was used to balance co-variates and generate odds of death for each observation. Odds ratios (venous vs. arterial) were charted against age. Results The in-hospital mortality rate was 1.12% (arterial) vs. 1.24% (venous) (p = 0.77). The overall 10-year survival was 74.6% (venous) vs. 82.6% (arterial) (p = 0.001). A total of 1226 patients were successfully matched to the venous or arterial (second conduit to circumflex territory after left internal mammary artery to left anterior descending artery) cohorts. Odds ratio for death (venous to arterial) showed a linear decremental overall survival benefit for the second arterial graft to circumflex circulation with increasing age. Conclusions The survival benefit of a second arterial graft persists through all age groups with a gradual decline with increasing age over the decades. Elderly patients should not be denied a second arterial graft to the circumflex circulation based on age criterion alone.

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The use of free versus in situ right internal mammary artery in coronary artery bypass grafting

Journal of Cardiac Surgery ◽

10.1111/jocs.15797 ◽

2021 ◽

Author(s):

Edgar Aranda‐Michel ◽

Derek Serna‐Gallegos ◽

Forozan Navid ◽

Arman Kilic ◽

Abraham A. Williams ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Internal Mammary

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Internal mammary artery versus autogenous vein for coronary artery bypass graft

The American Journal of Cardiology ◽

10.1016/0002-9149(74)90931-x ◽

1974 ◽

Vol 33 (1) ◽

pp. 167

Author(s):

Stephen J. Rossiter ◽

William R. Brody ◽

Jon C. Kosek ◽

Martin J. Lipton ◽

William W. Angell

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Internal Mammary ◽

Autogenous Vein

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Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

Case Reports in Cardiology ◽

10.1155/2012/652086 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Jonathan D. Gardner ◽

William R. Maddox ◽

Joe B. Calkins

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Rare Complication ◽

Artery Bypass ◽

Coronary Vein ◽

Arteriovenous Fistulas ◽

Asymptomatic Patients ◽

Internal Mammary

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

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