SATS 2009 Final Program - Scandinavian Association for Thoracic ...

P01:26
RETROTHYMIC ROUTING FOR SKELETONIZED INERNAL THORACIC ARTERIES:
OPTIMAL LENGTHS, BEST COURSE, MAXIMAL PROTECTION
Kargar Faranak 1 , Pooraliakbar Hamid-reza 1 , Yaghoubi Nahid 1 , Malek Hadi 1 , Aazami Mathias 1
1) Shahed Rajaei Heart Hospital, Iran
Introduction
Routing in-situ internal thoracic arteries (ITAs) towards their coronary targets is a salient technical aspect. The latter
should offer a smooth course providing maximal tension-free lengths, avoid technical flaws as graft kinking or errors
in angulations of sequential anastomoses, decouple in-situ ITAs from respiratory mechanics, and offer protection by
the time of re-sternotomy. In line with aforementioned prerequisites, we report on a new technique for routing of the
both right and left ITAs.
Patients and methods
Since 2007 to present, 158 patients (mean age 59.53±9.3 years; female: 25.6%; mean preoperative EF: 43 ±8.36 %;
mean logestic euroscore: 5.75 ± 6.5) underwent CABG using one or both skeletonized ITAs. The ITAs were routed
using the current technique in a retrothymic position towards LAD system, RCA or circumflex artery branches.
Results
158 left and 55 right in-situ ITAs were used. The mean number of grafts per patient was 2.9±0.8 (venous: 1.03±
1.1; arterial 1.87±0.96). 90 % of LITA was used to feed LAD system and 74% of RITA was anastomosed to RCA
branches. A composite arterial graft was performed in 22% and 20% of patients needed concomitant coronary
procedures. The overall hospital mortality was 1.8% and 3.6% of patients suffered perioperative MI mostly due to
extensive concomitant endarterectomy. None of the patients suffered phrenic nerve dysfunction.
Discussion
Retrothymic routing for ITAs is a safe and reproducible method. Decoupling in-situ ITAs from respiratory mechanics,
respecting the pleura, and avoiding splitting of the pericardium are some of its technical advantages.
P01:27
NUMBER OF CEREBRAL EMBOLI IS RELATED TO ACCESS SITE AT CORONARY ANGIOGRAPHY
Nyman Jesper 1 , Jurga Juliane 1 , Sarkar Nondita 1 , Tornvall Per 1 , Manilla Maria N. 1 ,
Svenarud Peter 1 , van der Linden Jan 1
1) Karolinska Institute, Sweden
Background
Stroke is a severe but unusual complication during coronary angiography (CA). Recent studies have shown that
particulate cerebral emboli are common during CA, but their role in this context is not entirely understood. The choice
of access site for CA might be of importance. The aim of this study was to evaluate if the number of particulate
cerebral emboli when a radial is compared with a femoral access site during CA.
Methods
Patients undergoing CA were randomized to a right femoral or a right radial access site. A transcranial Doppler
(Embodop, DWI, Germany) with bilateral probes was used to continuously register number of particulate emboli
passing each middle cerebral artery (MCA) during CA.
Results
Fifty patients were included, of whom 8 patients were converted from radial to femoral access and are not presented.
The total number of particulate emboli was higher with the radial than with the femoral access site (10.9 ± 6.3
versus 6.9 ± 4.7, p