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Abstract Background Precise identification of coronary arteries and selection of anastomotic sites are critical stages of coronary bypass surgery. Visualization of coronary arteries is occasionally challenging when the heart is covered with a thick layer of fat or scar tissue. In this paper, we review the methods to localize the coronary arteries during coronary surgery. Methods Prior publications were searched to summarize all available methods for localization of coronary arteries during coronary surgery. Results Five clinically recognized and three experimental techniques from the literature review are reviewed and summarized. Conclusions Knowledge of various techniques of coronary artery identification in hard-to-see coronary arteries is an important asset in coronary surgery and especially useful during the most critical option of the most common heart surgery.

Background: The long saphenous vein is routinely used for coronary bypass graft (CABG) surgery, and two primary techniques are commonly utilized: endoscopic vessel harvesting (EVH) and open vessel harvesting (OVH). The aim of this study was to compare the clinical outcomes of the EVH and OVH techniques used for CABG within the confines of a tertiary hospital. Methods: The clinical data of all patients subjected to either EVH or OVH for CABG surgery between 2014 and 2018 were retrospectively analyzed. Statistical analysis was performed to discern variations in the rates of postoperative complications between EVH and OVH. Results: A cohort of 1884 individuals were included in this study, 75.3% of whom underwent EVH. Notably, the incidence of postoperative leg wound complications was significantly different between the patients who underwent OVH and the patients who underwent EVH, with incidence rates of 18.6% and 32%, respectively (p < 0.001). Leg wound complications (p < 0.001; OR 1.946; 95% CI 1.528–2.477) and leg wound infections (p = 0.050, OR 1.517, 95% CI 0.999–2.303) were significantly associated with OVH. Moreover, leg wound hematoma (p = 0.039, OR = 0.402, 95% CI = 0.169–0.957) and EVH were strongly associated. Conclusions: The large sample of patients and the inclusion of a range of Asian ethnic groups provided notable insights into postoperative complications related to different modalities. EVH was associated with a lower incidence of postoperative leg wound complications, which suggests that EVH is a better modality for those undergoing CABG surgery.

Symptomatic vertebrobasilar atherosclerotic disease is rarely encountered but represents a high-risk factor for recurrent transient ischemic attack or stroke. Posterior strokes are usually associated with embolism or hemodynamic impairment. Extensive disease involving the V3 and V4 segments of the vertebral artery (VA) remains infrequent, and optimal management is limited owing to the infrequency of this disease. We illustrate the case of a 65-year-old man who presented with recurrent transient episodes of dizziness with acute onset of instability, nausea, and left visual blurring. Magnetic resonance imaging findings of the head were normal, and computed tomography angiography revealed severe atherosclerotic disease of both VAs, with proximal occlusion of the right VA and multiple tight stenoses of the left VA at the V1 and V4 segments. Duplex ultrasound found markedly reduced anterograde flow in the VAs and basilar arteries and nonsignificant stenosis of the internal carotid arteries. Optimal medical treatment led to a decrease of transient symptoms. However, the patient developed a cerebellar infarction in the left posteroinferior cerebellar artery territory with left VA V4 segment occlusion. Surgical revascularization of the right VA was decided by the multidisciplinary team. Through an anterolateral approach of the right VA V3 segment, revascularization was performed using a common carotid artery-to-right VA bypass using a reversed saphenous vein graft. The patient fully recovered and was free of symptoms during the next 14 months of follow-up. In the case of extensive VA occlusive disease, surgical reconstruction of the distal VA using a bypass from the common carotid artery represents an option to improve hemodynamics and/or eliminate an embolic source of posterior stroke on a case-by-case basis.

Objectives: Coronary artery bypass grafting (CABG) is performed using anatomic guidance. Data connecting the physiologic significance of the coronary vessel stenosis to the acute physiologic response to grafting are lacking. The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study is the first to compare preintervention coronary physiology with the acute regional myocardial perfusion change (RMP-QC) at CABG in a per-graft analysis. Methods: Non-emergent patients undergoing diagnostic catheterization suitable for multivessel CABG were enrolled. Synergy between Percutaneous Coronary Intervention with Taxus score, fractional flow reserve (FFR), instantaneous wave free ratio (iFR), and quantitative coronary angiography was documented in 75 epicardial coronary arteries, with 62 angiographically intermediate and 13 severe stenoses. At CABG, near-infrared fluorescence analysis quantified the relative change (post- vs pregrafting, termed RMP-QC) in the grafted vessel's perfusion territory. Scatter plots were constructed for RMP-QC versus quantitative coronary angiography and RMP-QC versus FFR/iFR. Exact quadrant randomization test for randomness was used. Results: There was no relationship between RMP-QC and quantitative coronary angiography percent diameter stenosis, whether all study vessels were included (P = .949) or vessels with core-lab quantitative coronary angiography only (P = .922). A significant nonrandom association between RMP-QC and FFR (P = .025), as well as between RMP-QC and iFR (P = .008), was documented. These associations remained when excluding vessels with assigned FFR and iFR values (P = .0092 and P = .0006 for FFR and iFR, respectively). Conclusions: The Collaborative Pilot Study to Determine the Correlation Between Intraoperative Observations Using Spy Near-Infrared Imaging and Cardiac Catheterization Laboratory Physiological Assessment of Lesion Severity study demonstrates there is no association between angiographic coronary stenosis severity and the acute perfusion change after grafting; there is an association between functional stenosis severity and absolute increase in regional myocardial perfusion after CABG.

Coral reef aorta (CRA) is characterized by heavily calcified obstructive lesions in the aorta. Thoracic endovascular aortic repair (TEVAR) is an established, less invasive procedure for aortic diseases; however, aortic occlusive diseases are commonly treated with conventional open surgery, and there are no reports of TEVAR in patients with a saccular aneurysm in CRA. We present a 72-year-old frail woman with a descending thoracic saccular aneurysm in CRA; therefore, we performed TEVAR. Although we had difficulty in advancing the stent graft system because it was caught in the severely calcified aorta, we finally succeeded in excluding the aneurysm.

Coronary Artery Bypass Grafting (CABG) is aimed to improve the quality of life among post-CABG patients, there exist a large number of patients having a low level of quality of life. The study aimed to analyze factors that influenced the quality of life among post-CABG patients. The descriptive study was conducted using cross-sectional analysis with a consecutive sampling of 80 post CABG patients in Hasan Sadikin Hospital from 20 May-30 June 2019. Data were analyzed using multivariate linear regression. The independent variables in this study included age, gender, education level, pain, mental health, social support, spiritual well-being, and cardiac rehabilitation. The data were collected using three questionnaires which included Short-Form 36 (SF-36) to measure patient-reported pain, mental health, and the quality of life; Multidimensional Scale of Perceived Social Support (MSPSS) to provide information about the role of social support; and Spirituality Index of Well Being (SIWB) designed to measure the spiritual well-being of the patients. The results showed four factors had significantly influenced the quality of life among patients after CABG. The factors included age (p-value0,001; r=0,521), pain level (p-value0,001; r=0,666), mental health (p-value0,001; r=0,426), and social support (p-value0,001; r=0,345). Pain factor had the most significant effect on the patients (r=0,497). Pain could cause a stress response that influenced the recovery stage which eventually impacted the quality of life. This study implies that the management of post-CABG patients could be performed by applying pain and stress management in discharge planning.

PurposeTo investigate the characteristics of cerebral perfusion and hemodynamics of bypass grafting in the treatment of moyamoya disease (MMD) using the iFlow color-coded flow map in comparison with magnetic resonance imaging–perfusion-weighted imaging (MRI–PWI) and computational fluid dynamic (CFD) analysis.Materials and MethodsPatients with MMD treated with bypass grafting who had undergone MRI PWI and digital subtraction angiography for iFlow color-coded map was retrospectively enrolled and CFD was performed for calculating the hemodynamic stresses around the bypass grafting.ResultsForty-five patients with unilateral MMD treated with bypass surgery were enrolled. The bypass surgery was successful in all patients, with no severe neurological complications during the periprocedural period. Followed up for 4–12 months (median 5.5), the neurological function was good in all patients. The cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were significantly (p < 0.05) improved in the middle cerebral artery distribution area on the surgical side before and after vascular bypass, and the difference of TTP (s) measured from the proximal bifurcation of common carotid artery to the confluence of sinus was also significant (p < 0.05). A significant (p < 0.05) positive correlation existed in the perfusion parameters between the iFlow blood perfusion and the MRI–PWI perfusion, with r-value for TTP of 0.765 (p < 0.01). The iFlow color-coded blood flow map showed warm color changes on the diseased side, similar to those on the contralateral side. In CFD analysis, the hemodynamic stresses were all improved, in and around the bypass grafting and distal vessels, which were beneficial to blood flow entering distal arterial branches.ConclusionThe iFlow color-coded flow map can be used to analyze cerebral perfusion after bypass grafting for MMD, similar to MRI–PWI, and CFD can be used to analyze the hemodynamics after bypass grafting, revealing improved hemodynamics to promote blood flow entering distal arteries.

Purpose: The study aimed to share the short-term mortality rates of coronary artery bypass grafting (CABG) experience in a private hospital and to evaluate parameters affecting the clinical outputs following the CABG who were divided according to the number of vessel graft. Materials and Methods: The study is a longitudinal-term observational clinical study, with a patient follow-up period of 7 years in Turkey. We analyzed 3027 cases with outcomes and short-term mortality according to the number of vessel grafts that we used as 1 (n:608), 2-3 (n:1359), and four or more (n:1060) grafts. Results: The short-term mortality was found as 1.1% (36/3027) in all the patients. The male population was the highest in the group with the highest number of vascular grafts and its percentage to females was correlated with vessel grafts that we performed. Mean aortic cross-clamp time was 36.6±17.2 minutes, while bypass time was 66.4±21 minutes. The mean number of vessels revascularized was 3.17±0.9 (1-7). The amount of drainage was 419±286 ml. The period of intensive care was 1.2±1.1 days, while the hospital period was 5.2±1.5days. In comparison according to the number of vascular grafts, positive inotrope agent, drainage, blood supply, cross-clamp and pump period showed significant difference. Conclusion: The number of vessel grafts was related to clinical outputs of CABG operations and Our CABG in the private hospital reached the short-term mortality rates that were below the averages of Turkey and international operations.

Objective To compare the efficacy and outcomes of surgical operations (myotomy and bypass surgery) and coronary stenting for treatment of coronary myocardial bridge. Methods We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang database for studies of treatment of coronary artery myocardial bridge with coronary stenting, myotomy or coronary artery bypass grafting. The data were extracted from the eligible studies, and regression analysis was performed to explore the sources of heterogeneity in the sample size, surgical methods, nations (Asian and others), and year of publication. Results There were 3 584 English articles and 1 678 Chinese articles reviewed in this study, and finially 4 019 articles were recruited after removing duplicate ones. Thirty-three eligible studies involving a total of 1 286 patients were included in the qualitative analysis. A total of 572 patients from 26 studies were included in the quantitative analysis. Analyses of the single rates showed that the overall symptom remission rate of myocardial bridge was 88.00% (95% CI: 81.31%-93.56%) following surgical interventions, which were associated with an overall postoperative coronary artery restenosis rate of 9.09% (95% CI: 4.30%-15.05%) and overall rates of intraoperative complications and postoperative cardiovascular events of 0.59% (95% CI: 0.00%-1.83%) and 0.46% (95% CI: 0.00%-1.63%), respectively. Regression analysis showed that postoperative symptom relief and coronary artery restenosis rates were significantly correlated with the surgical methods used (P < 0.001) but not with the sample size, year of publication, or nationalities of the patients (P > 0.1). Subgroup analysis showed that compared with interventional treatment, surgical treatments resulted in a significantly higher rate of postoperative symptom relief (95.45% vs 68.82%, P < 0.001) and lower rates of coronary artery restenosis (3.89% vs 21.78%, P < 0.001) and postoperative cardiovascular events (0.01% vs 2.91%, P < 0.001). The incidence of intraoperative complications did not differ significantly between surgical and interventional treatments (1.65% vs 0.00%, P=0.1405). Conclusion Surgical treatments result in a higher rate of postoperative symptom relief and a lower postoperative restenosis rate than interventional treatment, but high-quality randomized controlled trials with a large sample size are still needed to verify this conclusion.

Surgery in a patient with hepatic cirrhosis entails risk of complications and of death. Association of end stage renal disease (ESRD) along with cirrhosis further increases perioperative risk of morbidity and mortality. There are no reports in the literature of patients with liver cirrhosis and ESRD having undergone cardiac surgery. We present a report of a successfully operated case of ESRD with compensated hepatic cirrhosis posted for coronary artery bypass grafting.

OBJECTIVE. The authors developed a low invasive method of bimammary coronary artery bypass grafting (CABG) of minimum two arteries through left-sided thoracotomy. MATERIAL AND METHODS. The left internal thoracic artery was used for bypass grafting of anterior interventricular artery according to V.I. Kolesov method. Anastomosis of the right interventricular artery with conduit (from autoartery or autovein) was performed by using extrapleural way in the second intercostal space from the right of the breast. Conduit was lengthened behind the sternum to pericardium cavity in order to create the second distal anastomosis with branch of coronary artery. RESULTS. The operations (10 cases) were conducted at the period from October 2015 to December 2016. The second distal anastomosis between conduit and coronary artery was performed with diagonal artery in 1 case, with branch of blunt edge in 5 cases and with posterior interventricular branch in 4 cases. Tolerance of operation and early postoperative period were satisfactory. CONCLUSIONS. New method of bimammary coronary artery bypass allowed doctors to perform revascularization minimum of two coronary vessels on working heart by avoiding manipulations on aorta and the sternum.

The purpose of this study was to compare the renal function in patients undergoing coronary artery bypass grafting in off-pump and on-pump having pre-operative impaired renal function. In the on-pump, the serum creatinine and urea levels were significantly increased on post-operative day 1, 3 and 7. On day 1, it was maximum, then gradually decreased but not reached to pre-operative level. In case of off-pump, serum creatinine and urea levels were significantly increased on post-operative day 1 and 3. On day 1, it was maximum. Then decreased and the serum creatinine reached below pre-operative level on day 7. In case of on-pump, the creatinine clearance rate was significantly decreased on post-operative day 1, 3 and 7. On day 1, it was minimum. Then gradually increased but not reached the pre-operative level. In case off-pump, the creatinine clearance rate was significantly decreased on day 1 and 3. On day 1, it was minimum, then gradually increased and reached above the pre-operative level. A significant low level creatinine clearance rate was observed in on-pump group. Renal function was better preserved in patients undergoing off-pump in comparison to on-pump coronary artery bypass grafting.

Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE) and transesophageal echocardiography (TEE) was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA) with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male) with complete ruptures of papillary muscle following acute myocardial infarction (AMI). Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.

The internal thoracic artery is often used for reconstruction of coronary arteries. In a proportion of cases the reasonfor bypass failure (internal thoracic artery – coronary artery) is abnormal blood flow in the subclavian artery resultingfrom its stenosis. The stricture can result from post-surgery progression of atherosclerosis or could have been presentand undiagnosed already when cardiac surgery was performed. This may result in exercise angina or even acute coronarysyndrome. Interventional intervention is inevitable in these cases. An 84-year-old man was admitted for unstableangina 7 years after coronary artery bypass grafting (CABG) from the internal thoracic artery to the left anteriordescending branch of the left coronary artery. In spite of medical treatment the symptoms did not recede and coronaryand bypass angiography was performed on the 4th day of hospitalization, revealing multiple stenoses of thecoronary arteries and severe stenosis of the left subclavian artery. Moreover, the symptoms subsided only slightlyafter angioplasty of the circumflex branch of the left coronary artery. For this reason, angioplasty of the left subclavianartery with stent implantation, widening of the right coronary artery aortic opening, and angioplasty of the leftcoronary artery trunk and of the circumflex branch at its origin were performed. These procedures resulted in completecessation of angina, while the patient also observed significant improvement of his left upper limb performance.The coronary-subclavian steal syndrome is defined as reduced flow through the bypass (internal thoracic artery –coronary artery) or reversed flow through the bypass, as a result of the narrowing of the proximal part of the left subclavianartery. In most cases the symptoms are stable and chronic, but in some patients an acute coronary syndromecan develop. Additionally, there are usually disturbances of the left upper limb perfusion. Routine blood pressuremeasurement on both arms is believed to identify a group of patients with high probability of subclavian artery stenosis,who may benefit from supplementation of coronary angiography with aortic arch imaging. Traditional surgicalmethods of treatment for subclavian-coronary steal syndrome include bypass between the left common carotid andleft subclavian artery. However, intravascular angioplasty with stent implantation is a contemporary method of choice.Intravascular methods allow simultaneous correction of coronary vessels when there is a recurrent stenosis.