[Off-pump CABG].
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Coronary Artery Bypass, Off-Pump↗
Biomedical subjects
Atsushi Amano
Publications and source records attributed to Atsushi Amano.
Alterations of phosphorylation state of connexin 43 during hypoxia and reoxygenation are associated with cardiac function.
Gap junctions formed by connexins mediate cell-cell communication by electrical and chemical coupling. Recently, it has been shown that alterations in the phosphorylation state of the connexins result in functional alteration of cell-cell communication through gap junctions. Therefore, we focused on the association of alterations of phosphorylation state of connexin 43 (Cx43) with cardiac function in vivo. Rat hearts were transferred to Langendorff apparatus and submitted to hypoxia and then reoxygenated. In the control heart, Cx43 was phosphorylated and located at the intercalated disk. When the hearts were subjected to hypoxia, Cx43 at gap junctions was dephosphorylated and changed its localization to the entire plasma membrane. The area of cardiomyocytes stained with anti-phosphorylated Cx43 antibody was decreased in a time-dependent manner. Immunoblot data supported the decrease of phosphorylated Cx43 during hypoxia. ZO-1 did not change its localization at the intercalated disk during the hypoxic period. We also found that the area occupied by dephosphorylated Cx43 was correlated with the decrease of percent of rate-pressure product. These data indicate that dephosphorylation and redistribution of Cx43 is an early sign of cardiac injury after hypoxia. Detection of dephosphorylated Cx43 may serve as a diagnostic tool for examining ischemic heart disease.
Animals↗
Systematic off-pump coronary artery bypass.
PURPOSE: We assessed the feasibility of systematic off-pump coronary artery bypass (OPCAB) and identified risk factors for on-pump conversion. METHODS: Between July 1, 2002 and December 31, 2003, OPCAB was attempted for all patients who required isolated coronary artery bypass in our institution. The perioperative results of patients were prospectively entered into a structured database, the results were analyzed to identify the risks of requirement of cardiopulmonary bypass. RESULTS: OPCAB was performed in all but 4 patients, giving an OPCAB success rate of 98.3% (229/233). The reason for cardiopulmonary bypass was hemodynamic instability occurring during reoperative surgery in 3, and cardiogenic shock in 1. The isolated risk factor for on-pump conversion was reoperation (relative risk 11.6). Mean number of distal anastomoses performed under OPCAB was 3.7+/-1.2, and the complete revascularization rate was 92.1% (211/229). There was one hospital death (0.4%). During a mean follow-up period of 1.0+/-0.4 years, two patients developed angina, which were treated with catheter intervention; otherwise, there was no death, or other cardiac events observed. CONCLUSION: Systematic OPCAB was feasible except in patients undergoing reoperative surgery or patients with on-going deep cardiogenic shock. Systematic OPCAB provided successful complete revascularization and its short term results were acceptable.
Aged↗
Skeletonized radial artery grafting: one-year patency rate.
BACKGROUND: The skeletonized radial artery harvesting technique has routinely been used in our institute. Its clinical outcome is acceptable; however, the graft patency rate at 1 year has not been reported. METHODS: Between July 1, 2003, and October 31, 2002, 50 consecutive patients underwent isolated coronary artery bypass using skeletonized radial artery grafts in our hospital. There were no hospital deaths or perioperative myocardial infarctions. All patients completed follow-up by November 2003. Twenty of these patients (18 asymptomatic volunteers and 2 symptomatic patients) underwent coronary angiography at 1 year, and the results were analyzed. RESULTS: At a mean (+/-SD) follow-up period of 1.2 +/- 0.2 years, there were no deaths. Two patients developed angina due to graft occlusion (1 in the radial artery and another in the gastroepiploic artery). Twenty-one radial artery grafts and 36 distal anastomoses with radial artery grafts were evaluated by angiography at 1 year (0.9 +/- 0.1 years). There was 1 radial artery graft occlusion affecting 1 distal anastomosis, giving a perfect graft patency rate of 95.2% (20/21) and a perfect anastomosis patency rate of 97.2% (35/36). The patient with the occluded radial artery graft had a history of peripheral vascular disease and diabetes. There were no graft stenoses or string signs. CONCLUSION: At our limited follow-up, the results of using skeletonized radial artery grafts are excellent. Extensive skeletonization will not affect the graft patency rate or early graft spasm. Careful examinations of the radial artery grafts in patients with a history of peripheral artery disease and diabetes are mandated.
Aged↗
Skeletonized gastroepiploic artery for off-pump coronary artery bypass grafting.
BACKGROUND: Skeletonized arterial grafting may reduce the risk of graft spasm and may improve graft patency. Previously we reported a pilot study of skeletonized gastroepiploic artery (GEA) grafting with favorable results. Skeletonized GEA harvesting with an ultrasonic scalpel has now become our routine procedure. In this report, we compare the early clinical outcomes of skeletonized versus pedicled GEA grafting to assess the safety and benefit of use of skeletonized GEA in coronary artery bypass grafting. METHODS: Between July 2002 and October 2003, the GEA was used as a conduit for isolated off-pump coronary artery bypass grafting in 105 patients. Of these, 21 patients (group P) received pedicled GEA and 59 patients (group S) received skeletonized GEA grafts (excluding 25 patients whose results were reported in the pilot study). The perioperative and early follow-up data were prospectively collected and compared. RESULTS: No graft injury was found in either group. The preoperative characteristics were similar in the two groups except that group S had a smaller body surface area (1.64 +/- 0.16 m 2 in group S versus 1.73 +/- 0.16 m 2 in group P, P <.05) and a significant number of patients with diabetes (36/59, 61.0% versus 7/21, 33.3%, P <.05). The number of distal anastomoses was 4.3 < 1.0 versus 3.9 +/- 0.9 ( P = not significant [NS]). An in situ GEA composite graft was constructed in 8 (13.6%) of the patients in group S and none of the patients in group P ( P = NS). There was one hospital death due to infection in group S. Otherwise, there were no cases of low output syndrome or postoperative myocardial infarction in either group. During early postoperative follow-up, no angina recurrence or myocardial infarction was found. CONCLUSION: The GEA can be skeletonized safely with an ultrasonic scalpel. Skeletonization enables a wider variety of choices in the use of GEA grafting.
Adult↗
Aortic nontouch off-pump complete revascularization using 3 in situ arterial conduits: bilateral internal mammary arteries and gastroepiploic artery.
BACKGROUND: Arterial grafts have been used frequently in recent coronary artery bypass grafting (CABG). Off-pump CABG can facilitate early patient recovery. A combination of in situ graft and off-pump technique results in complete aortic nontouch surgery; however, outcome has not been well established. METHODS: Between May 1998 and December 2001, 1035 consecutive isolated CABG operations were performed at Juntendo-Shin-Tokyo Hospital Group. Of these, off-pump CABG using in situ bilateral internal mammary arteries and in situ gastroepiploic artery was performed in 48 patients (41 men and 7 women; mean age, 74.5 +/-9.9 years). Perioperative and follow-up data were studied. RESULTS: The average number of distal anastomoses was 3.4 +/-0.7, and complete revascularization was achieved in all patients. There were no hospital deaths. Perioperative myocardial infarction was observed in 1 patient, congestive heart failure in 1, stroke in 2, and mediastinitis in 1. Postoperative catheterization was performed in 30 patients and revealed no graft occlusions. During the follow-up period of 2.3 +/- 1.2 years, no remote deaths, angina recurrence, or coronary interventions were observed. CONCLUSION: Off-pump CABG using an all in situ arterial graft can be performed safely, and follow-up results are excellent.
Adult↗
Off-Pump Coronary Artery Bypass Using Skeletonized Gastroepiploic Artery, a Pilot Study.
Abstract Background: The problem with using the gastroepiploic artery (GEA)for coronary artery bypass grafting (CABG) is vasospasm. To minimize vasospasm of the GEA, a skeletonized harvesting technique was used for GEA harvesting. We present the initial results of GEA grafting using this technique. Methods: Between September 1, 2002, and December 31, 2002, a total of 25 patients (21 men and 4 women, mean age 65.4 +/- 8.7 years) gave informed consent and underwent elective off-pump CABG using the skeletonized GEA. Skeletonization was completed using an ultrasonic scalpel (Harmonic scalpel, coagulating-scissors; Ethicon Endo-Surgery, Cincinnati, OH, USA). Follow-up data were available until August 31, 2003. Perioperative, early clinical, and follow-up results were analyzed. Results: There were no hospital deaths, perioperative myocardial infarctions, congestive heart failure, strokes, or renal failure. There were no abdominal complications. Follow-up data were available from all patients, with a mean follow-up of 0.8 +/- 0.1 years. There were no cardiac deaths or cardiac events. Conclusion: During our limited follow-up period, the early results of skeletonized GEA grafting were excellent, and cardiac events have been well controlled. Mid-term follow-up study and angiographic study are necessary to confirm our initial clinical outcome data.
Journal Article↗
Redo coronary artery bypass grafting: early and mid-term results.
OBJECTIVES: Redo coronary artery bypass grafting (CABG) has been gradually increasing in Japan. We prospectively collected redo-CABG data and evaluated these the early and remote results. METHODS: Between 01/01/1994 and 06/30/2002, a total of 71 patients underwent isolated redo-CABG in our hospital group. The interval between operations was 7.8 +/- 6.1 years. Previous surgery was CABG in all patients. Perioperative, early angiographic, and follow-up results were analyzed. RESULTS: The mean number of grafts was 2.9 +/- 1.2. There were 4 incidences of injury to the heart or graft during sternal re-entry or during dissection of the heart. There was 1 hospital death (2.8%) and 19 major complications (26.8%), including 7 patients (9.9%) with postoperative congestive heart failure and 2 (2.8%) with postoperative myocardial infarction. Postoperative angiography was obtained in 47 patients and their overall stenosis free patency rate was 93.9%. Follow-up was completed for all hospital survivors with a mean follow-up of 3.9 +/- 2.2 years. The event-free and survival rates at 5 years were 76.4% and 83.9%, respectively. CONCLUSION: In our limited experience, redo-CABG was performed with acceptable risks and its long-term results were satisfactory.
Adult↗
ONO-4817, a novel matrix metalloproteinase inhibitor, attenuates allograft vasculopathy in a rat cardiac transplant.
BACKGROUND: Cardiac allograft vasculopathy (CAV), a disorder characterized by rapid development and progression of obliterative vasculopathy in the transplanted heart, continues to be a major cause of graft failure in long-surviving human transplants. The mechanisms and histopathologic processes of CAV remain unknown. Previous animal studies have shown that inhibition of matrix metalloproteinase (MMP) prevents migration and proliferation of smooth muscle cells in CAV. In this study, we hypothesized that MMPs may be expressed in and may play an important role in CAV. METHODS: An F344-to-WKAH rat heterotopic heart transplantation model was used. Tacrolimus was administered intramuscularly 14 days after transplantation to prevent acute rejection and to allow the development of CAV. We divided the animals into 2 groups according to post-operative treatment: an ONO group received an MMP inhibitor (ONO-4817) daily by oral gavage for 14 days after transplantation (n = 6), and a control (n = 6) group received no treatment. Grafts were harvested 60 days after treatment. RESULTS: Immunohistochemical staining revealed that MMP-2 and tissue inhibitors of metalloproteinase-2 (TIMP-2) were expressed more strongly in the neointima and media of the control CAV animals than in the ONO-CAV animals. The animals given ONO-4817 exhibited a significant decrease in the percentage of affected vessels, in the percentage of intimal proliferation, in the intima-to-media ratio, and in the expression of MMP-2 and TIMP-2. CONCLUSION: These results suggest that MMP-2 and TIMP-2 play an important role in the development of CAV and that the use of an MMP inhibitor (ONO-4817) may prevent neointimal proliferation in patients with CAV.
Animals↗
Safe bilateral use of skeletonized internal thoracic artery in patients with diabetes.
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Coronary Artery Bypass↗
Synergistic effect of triptolide and tacrolimus on rat cardiac allotransplantation.
Recent studies have shown that triptolide inhibits T cell activation through mechanisms different from those of cyclosporine A and tacrolimus and we postulated that triptolide might have a synergistic effect with tacrolimus to enhance immunosuppression. Using a F344 donor-to-Lewis recipient rat combination, we investigated the immunosuppressive effects of triptolide alone or in combination with tacrolimus on the survival of cardiac allografts. Recipients were treated with placebo, triptolide, tacrolimus, and triptolide in combination with tacrolimus at different doses. The median survival time (MST) was 8 days for placebo; 9.5, 11, 14 and 19 days for triptolide monotherapy at doses of 0.04, 0.08, 0.16, and 0.32 mg/kg/day, respectively, and 11, 13.5, and 52 days for tacrolimus monotherapy at doses of 0.025, 0.05, and 0.1 mg/kg/day, respectively. Tacrolimus 0.025 mg/kg/day combined with triptolide 0.08 and 0.16 mg/kg/day prolonged the MST to 17.5 and 20 days, respectively; while tacrolimus 0.05 mg/kg/day combined with triptolide 0.04, 0.08, and 0.16 mg/kg/day prolonged the MST to 21, 23, and 23 days, respectively. These results suggest that triptolide is a moderately effective immunosuppressive agent. Triptolide combined with a subtherapeutic dose of tacrolimus produced a synergistic effect in prolonging rat cardiac allograft survival.
Animals↗
Venous coronary artery bypass grafting: late results of a 15-year actuarial follow-up in 486 patients.
PURPOSE: The aim of this study was to clarify the long-term results of venous coronary artery bypass grafting in Japanese patients. METHODS: The study population included 492 patients who underwent venous coronary artery bypass procedures at the Department of Cardiothoracic Surgery of Juntendo University from January 1984 to December 1989. The great majority of patients, 420 of 492 (85.4%), were males, and the mean patient age was 61.1 years (range: 32-82 years). The disease conditions included single-vessel disease in 32 patients (6.5%), double-vessel disease in 111 patients (22.6%), triple-vessel disease in 251 patients (51.2%), and 50% or more stenosis of the left main coronary artery in 98 patients (19.9%). A mean of 2.4 grafts was used per patient. RESULTS: The 15-year survival rate was 57.7%. The 15-year actuarial cardiac survival and cardiac event-free survival were 81.3% and 51.3%, respectively. The 15-year actuarial freedom from reoperation and myocardial infarction were 87.5% and 92.1%, respectively. Of 192 patients who died during the follow-up period, 62 deaths were due to cardiac causes (32.3%), 43 were due to malignant neoplasms (22.4%), and 25 were due to cerebral vascular accidents (13.0%). CONCLUSION: The prognosis of Japanese patients undergoing coronary artery bypass grafting may therefore be more favorable than that of Western patients. In addition, diabetes mellitus was an independent risk factor for both cardiac death and cardiac events.
Adult↗
Off-pump multivessel revascularization: efficacy of suction type of coronary stabilizer.
OBJECTIVE: Off-pump coronary artery bypass grafting (CABG) has come into widespread use with the availability adequate coronary stabilization devices. We studied the efficacy of second-generation coronary stabilization devices (suction device) comparing to the first-generation device (compression device). METHODS: We prospectively analyzed consecutive patients who underwent isolated off-pump CABG via a midline sternotomy at Shin-Tokyo Hospital Group between July 1, 1996, and August 31, 2000, comparing perioperative, and follow-up data in the group using a suction device (group S) to that in the group using a compression device (group C). RESULTS: Preoperative risk factors were identical between the two groups, with the exception of a higher incidence of three vessel disease in group S. Complete revascularization increased from 47.3% in group C to 88.1% in group S, and the number of distal anastomoses from 2.1 +/- 0.6 in group C to 2.9 +/- 0.9 in group S. Revascularization of the circumflex artery was achieved in 21.7% of group S patients, which was significantly higher than that in group C (2.2%). Postoperative recovery, mortality, and morbidity did not differ significantly between groups. Calculated event-free rates at 2 years was 88.7% in group C and 92.0% in group S (p = NS). CONCLUSIONS: Anastomosis to the posterior wall of the heart using the suction device is safe. An increased number of distal anastomoses may reduce the occurrence of cardiac events related to incomplete revascularization.
Aged↗
Coronary artery bypass grafting for patients with poor left ventricular function.
Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction: group 1 comprised 131 patients with poor left ventricular function (ejection fraction < 40%); group 2 was 1,496 control patients. The mean number of distal anastomoses was not significantly different in the 2 groups, however, clamp time, pump time, and operative time were longer in group 1. Patient recovery was significantly slower in group 1. Morbidity (14.5% in group 1 versus 7.4% in group 2, p < 0.005) and mortality (2.3% versus 0.1%, p < 0.0001) were higher in group 1. During late follow-up, the 5-year survival rate (70.1% versus 90.5%) and 5-year event-free rate (65.6% versus 81.9%) were significantly inferior in group 1 compared to group 2. The results of bypass surgery in cases of decreased left ventricular function were poor, and such patients need to be carefully followed up.
Adolescent↗
Skeletonization of the radial artery with the ultrasonic scalpel: clinical and angiographic results.
BACKGROUND: To improve the patency rate of the radial artery graft, we have been using a skeletonized harvesting technique since September 1, 2001. Our early reports confirmed better graft patency of the skeletonized radial graft than the conventional pedicled graft. However, its midterm results were unknown. We present our recent experience and follow-up results of radial artery grafting using the skeletonized harvesting technique. METHODS: Between September 1, 2001, and July 31, 2002, 391 patients underwent isolated coronary artery bypass surgery in our hospital group, excluding minimally invasive direct coronary bypass procedures via small thoracotomy or T-grafting. Among them, skeletonized radial grafting was performed in 246 patients (182 men and 64 women; mean age, 66.2 +/- 9.5 years). Follow-up is to be completed by December 31, 2003. Perioperative, early angiographic, and follow-up results were analyzed. RESULTS: There were 1 hospital death and 5 incidences of postoperative myocardial infarction. None of these occurrences were related to radial artery bypass. Early angiography revealed that the stenosis-free graft patency rate of radial artery anastomoses (291/303 cases, 96.0%) was not significantly different from the patency rates of surgeries involving the use of other conduits (left internal mammary artery, 95.1%; right internal mammary artery, 93.8%; gastroepiploic artery, 93.1%; and saphenous vein, 98.2%). Follow-up was completed for all hospital survivors with a mean follow-up time of 1.4 +/- 0.3 years. There were no cardiac deaths and 5 cardiac events, giving a cardiac event-free rate of 97.5%. CONCLUSION: In our limited follow-up, cardiac events have been well controlled. Midterm follow-up angiographic study is necessary to confirm our clinical outcome data.
Adult↗
Minimally invasive direct coronary artery bypass: current experience.
BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) via a small incision has been performed for revascularization of the left anterior descending artery with the left internal mammary artery. In this study, we analyzed outcome in patients who underwent MIDCAB. METHODS: Between June 1997 and July 2002, a total of 125 patients (96 men and 29 women; mean age, 65.1 +/- 9.6 years) underwent MIDCAB. Perioperative and follow-up data were entered into a structured database. RESULTS: Coronary anastomosis time was 17.0 +/- 5.0 minutes. Mean intubation period, intensive care unit stay, and postoperative hospital stay were 4.0 +/- 2.8 hours, 1.3 +/- 0.8 days, and 9. 7 +/- 4.6 days, respectively. There were no hospital deaths or cases of postoperative heart failure, myocardial infarction, renal failure, prolonged ventilation (>2 days), or stroke. During the follow-up period of 3.3 +/- 1.5 years, 12 patients developed angina, and there were 10 deaths. The actuarial 3-year survival rate was 92.6%, and the event-free rate was 87.1%. CONCLUSION: MIDCAB can be performed with early recovery with minimum mortality and morbidity. The longterm results after MIDCAB are acceptable.
Aged↗
Skeletonized radial artery grafting: improved angiographic results.
BACKGROUND: The radial artery has been used for coronary artery bypass grafting (CABG) but its early angiographic results were relatively inferior to that of the internal mammary artery, most likely due to spasm of the graft. To avoid vasospasm we harvested the radial artery using a skeletonized technique and spasm was completely reversed before use. The graft patency of the skeletonized radial artery was compared with the radial artery graft harvested as a pedicle. METHODS: A total of 112 patients underwent isolated CABG using a pedicled radial artery between September 1, 1999, and August 31, 2000 (group P), and a total of 131 patients with a skeletonized radial artery between September 1, 2000, and August 31, 2001 (group S). An ultrasonic scalpel (Harmonic Scalpel; Ethicon EndoSurgery, Cincinnati, OH) was used for skeletonization and removing satellite veins and surrounding tissue. CABG was performed by the standard technique. Perioperative results were prospectively collected and compared between the two groups. Early angiographic results performed within 3 months were also compared. RESULTS: There were two hospital deaths in group S. Major complications were observed in 11 (8.4%) in group S and 3 (2.7%) in group P (p = not significant [NS]). None were related to the radial artery graft. Angiography was obtained in 96 patients of group S and 76 patients in group P and revealed that the stenosis free graft patency rate of group S (138 of 143, 96.5%) was superior to that of group P (73 of 86, 84.9%) with p < 0.005. CONCLUSIONS: Skeletonization of the radial artery with the ultrasonic scalpel is safe and contributes to reducing the incidence of early graft stenosis.
Adult↗
Composite graft using the gastroepiploic artery, regarding the study design.
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Coronary Artery Bypass↗