Tissue-engineered vessels offer options for autologous vascular grafts in cardiovascular repair and regeneration. The experiments aimed to construct functional arterial grafts by combining human hair ...follicle mesenchymal stem cells (HF-MSCs) with acellular umbilical arteries. We isolated mesenchymal stem cells from human hair follicles. Under appropriate culture conditions, these cells displayed CD44, CD90 and CD105, and exhibited the potential for differentiation to adipocytes, osteoblasts and chondrocytes. Very promisingly, HF-MSCs expressed the vascular smooth muscle specific markers in the presence of transforming growth factor-β. We created acellular arterial scaffolds by digesting human umbilical arteries with trypsin and sodium dodecyl sulfate. These acellular arterial scaffolds retained major components of the extracellular matrix. The mechanical properties of these acellular arterial scaffolds were very similar to those of native blood vessels. We then seeded HF-MSCs into acellular arterial scaffolds and found that they still expressed vascular smooth muscle specific markers. The arterial grafts derived from HF-MSCs demonstrated vasoreactivity in response to humoral constrictors. We constructed arterial grafts that are very close to native blood vessels in their structures and physiological functions. These properties suggest that these arterial grafts could be used as small diameter arterial grafts for cardiovascular repair and regeneration.
Bilateral internal mammary artery (BIMA) grafting has a good long-term survival rate and graft patency rate, but it is only recommended in young patients due to its high technical requirements and ...high incidence of sternal complications. Previous studies indicated that BIMA grafting has a significant benefit in patients aged 50-59 years, but this benefit does not extend to patients aged > 60 years. Thus, this study was designed to analyse the immediate artery graft function, short-term (3 months) results, and experience in preventing sternal complications for BIMA grafting in elderly patients (60-75 years old).
Clinical records and echocardiographic and coronary artery computed tomography angiography data of 155 patients who underwent BIMA grafting for coronary artery disease between 2015 and 2017 in our hospital were analysed retrospectively to summarise the operative experience and short-term (3 months) results. Patients were divided into two groups: Group A (n = 95), aged < 60 years and Group B (n = 60), aged 60-75 years. The operation time, aortic clamp time, and cardiopulmonary bypass time of these two groups were compared to analyse the operation difficulty and the flow and pulsatility index were compared to analyse the immediate artery graft function. The left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) of these two groups were compared to analyse heart function.
There were no significant differences in the operation time, aortic clamp time, and cardiopulmonary bypass time as well as the flow and pulsatility index between these two groups (P > 0.05). There was no significant difference in the incidence of sternal wound complications, graft occlusion, and other common complications 3 months post-BIMA grafting between these two groups (P > 0.05). Furthermore, there was no significant difference in LVEDD and LVEF between the groups 3 months post-operation (P > 0.05).
BIMA grafting was safe and effective for older patients (60-75 years). Similar to younger patients (< 60 years), BIMA grafting in elderly patients (60-75 years) can also achieve a satisfactory short-term (3 months) result. Thus, advanced age (60-75 years) should not be a contraindication for BIMA grafting.
There is no evidence for the increasing use of percutaneous coronary intervention (PCI) compared with surgery in patients with left main coronary artery (LMCA) disease. We compared the clinical ...outcomes of patients with LMCA disease who had undergone PCI with those of patients who had off-pump coronary artery bypass (OPCAB) grafting.
From January 2001 to December 2009, 899 patients with LMCA disease were treated with OPCAB (n = 553) or PCI (n = 346). Analyses using propensity-score matching were performed to minimize the selection bias. We compared major adverse cardiac and cerebrovascular events (MACCE) including death, stroke, acute myocardial infarction and target-vessel revascularization. The median follow-up was 55.9 months.
For the 159 propensity-matched pairs, the early mortality in the OPCAB group was lower than in the PCI group (0 vs 5%, the PCI group; P < 0.001). Overall survival at 8 years was similar between groups (88.6 ± 3.5%, the OPCAB group vs 85.8 ± 5.3%, the PCI group; P = 0.394). Freedom from MACCE at 8 years was significantly higher in the OPCAB than in the PCI group (83.9 ± 5.1 vs 60.2 ± 6.9%, P < 0.001). Although there was no intergroup difference in the risk of death hazard ratio (HR) for the PCI group, 1.435; 95% confidence interval (CI), 0.62-3.31; P = 0.396, a significant difference was found in the risk of MACCE (HR for the PCI group, 4.193; 95% CI, 2.165-8.121; P < 0.001). This difference was primarily due to a higher risk of acute myocardial infarction (HR for the PCI group, 4.730; 95% CI, 0.99-22.63; P = 0.049) and higher rates of target-vessel revascularization (HR for the PCI group, 5.508; 95% CI, 1.87-16.22; P = 0.002).
Compared with PCI, OPCAB is associated with a lower incidence of MACCE in patients with LMCA disease, determined mainly by the lower incidences of acute myocardial infarction and target-vessel revascularization. The incidence of stroke in the OPCAB group was similar to the PCI group.
Purpose
Over the past three decades, there have been a plethora of retrospective observational data and meta-analyses which support the hypothesis of improved clinical outcomes using bilateral ...internal thoracic arteries (BITA) when compared to saphenous vein grafts (SVGs). However, recently published results have brought this thinking into doubt. We discuss the existing literature on the subject and attempt to clarify the appropriate use of BITA in coronary artery bypass surgery (CABG).
Methods
A review of all existing meta-analyses on BITA was conducted to better understand the utility of BITA in CABG. A review of the largest randomized controlled trials on the subject was then compared to the observational data.
Results
In all existing meta-analyses, BITA shows a significant advantage over the use of a single internal thoracic artery (SITA) with SVGs. The two largest randomized controlled trials evaluating BITA failed to show a survival advantage and brought into question the complications associated with BITA.
Conclusions
At present, the use of multiple arterial grafts remains a reasonable choice, particularly in young patients, provided that their use does not increase the operative risk. Further evidence currently being collected may lend a definitive answer in the near future.
Objective The learning curve of coronary artery bypass grafting (CABG) with multiple arterial grafting (MAG) is perceived to be associated with increased surgical morbidity and potentially poorer ...long term outcomes. We compared short term outcomes and long term survival in patients who underwent CABG with MAG performed by attending surgeons or resident trainees at a single institution over a period of 19 years. Methods Using our institutional database, we identified 3039 patients undergoing MAG from 1996 to 2015. Of those, 958 (32%) were operated by residents and 2081 (68%) by attending surgeons. Propensity score matching and mixed effect models were used to compare the two groups. Results Operative mortality was 0.3% and 0.4% among patients operated by residents and attending surgeons respectively (P=0.71) with no significant differences between the groups in postoperative complications. After a mean follow-up time of 11±4 years, survival probability at 5,10 and 15 years was 95.1%±0.7% versus 96.4%±0.6%, 87.0%±1.1% versus 87.8%±1.1% and 76.6.%±1.8% versus 77.6%±1.8% in the resident and attending surgeon group respectively. Resident and attending surgeon cases showed comparable risk of death (HR 1.01; 95%CI 0.80–1.28; P=0.92). The equipoise between the two groups was confirmed among cases receiving bilateral internal thoracic arteries only (HR 0.88; 95%CI 0.54–1.43; P=0.61), radial artery (HR 1.22; 95%CI 0.92–1.61; P=0.15) or their combination (HR 0.74; 95%CI 0.33–1.65; P=0.47). Conclusions The present analysis confirms that adequately supervised trainees can perform CABG with multiple arterial grafting without compromising patient safety and long term survival.
Background Extended left internal thoracic artery (LITA) harvesting allows maximal grafting to the anterior and lateral walls with a single ITA conduit. This study evaluates outcomes following the ...use of a LITA Y graft as the primary grafting strategy. Methods Patients who underwent LITA composite Y-grafting (n=198) between 1995 and 2009 were identified from a cardiac surgical database. Follow-up (mean 13.1 years) was obtained by cross-reference with the state death registry and local cardiology databases. Results Operative mortality was zero in the 168 patients who underwent isolated CABG and was 3.5% overall. There were no episodes of perioperative myocardial infarction. Kaplan-Meier 10-year survival was 75.9%. Independent predictors of worse late survival were age, diabetes, chronic obstructive pulmonary disease and pre-existing left ventricular dysfunction. There were 53 episodes of post-discharge angiography at an average of 5.8 years post LITA Y grafting. Twenty cases of LITA Y graft failure were identified, predominantly affecting the free limb (n=15). The ratio of symptom driven angiography to Y graft failure increased over time. Eighteen patients required revascularisation, percutaneous intervention in 15 and reoperative coronary bypass in three. Conclusions Left Internal Thoracic Artery Y grafting is a feasible revascularisation strategy with satisfactory outcomes. These are comparable to other arterial composite graft configurations. A LITA Y allows efficient conduit use without compromising the in situ LITA graft.
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