- Email: [email protected]
OP-307 AN UNUSUAL TECHNIQUE FOR SUPERIOR MESENTERIC ARTERY REVASCULARIZATION
S78
Oral Presentations / International Journal of Cardiology 155S1 (2012) S1–S89
very useful diagnostic tools for recongize graft associated fatal complications. MDCT may offer detailed anatomic and functional data in these patients.
to preserve its patency. When SMA stenting fails, open bypass from the descending aorta and iliac arteries is problematic and dangerous because of the dissected fragile wall. Using the ascending aorta as an inflow might be a safe and valuable alternative to restore flow to the SMA. Conclusions: Exotic surgical bypasses like AA to SMA in a special setting such as type B dissection is a valid alternative when other traditional measures fail or becomes technically impossible. Saturday, 3 March 2012
17:00–18:30
Challenges in Surgical Treatment of Coronary Artery Disease OP-310 COMPARISON BETWEEN SURGICAL PATCH RECONSTRUCTION AND MULTIPLE STENTING INDIFFUSELY DISEASED LEFT ANTERIOR DESCENDING CORONARY ARTERY G.A. El Attar1 , M.A. El Anwar2 , A.M. Ibrahim3 , M.H. Abdou Allam4 . 1 Department of Cardiology, Suez Canal University, Ismailia, Egypt; 2 Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt; 3 Department of Cardiology, Ain Shams University, Cairo, Egypt; 4 Department of Cardiology, National Heart Institute, Cairo, Egypt
Figure 1.
Saturday, 3 March 2012
15:30–17:00
Interventions in Peripheral Arterial Diseases OP-307 AN UNUSUAL TECHNIQUE FOR SUPERIOR MESENTERIC ARTERY REVASCULARIZATION Y. Zorman, G. Gemayel, D. Mugnai, P. Mootoosamy, N. Murith, A. Kalangos. Department of Cardiovascular Surgery, University Hospital of Geneva, Switzerland Objective: Endovascular surgery became the mainstay of superior mesenteric artery (SMA) revascularization. When it is not technically feasible, different surgical options exist and classically consist of a retrograde or an antegrade bypass from the distal and the supracoeliac aorta respectively. We describe an unusual technique of SMA bypass using the ascending aorta as inflow. Methods: A 47 year old female was admitted to our hospital for a complicated type B aortic dissection with dynamic ischemia of the visceral renal arteries. She underwent an urgent endovascular fenestration to expand her collapsed true lumen but subsequently developed acute thrombosis of the SMA. After an initial failed attempt to stent the SMA, an urgent ascending aorta (AA) to SMA bypass was successfully performed using an ePTFE graft. The choice of the proximal anastomosis on the AA was dictated mainly by the absence of an adequate more distal site in a frail dissected wall of the whole descending aorta reaching both external iliac arteries. The patient did well and was discharged from the hospital at day 21 with a patent graft. Results: While stent graft placement is the treatment of choice of complicated type B dissection, endovascular aortic fenestration is a valid second alternative specially in dynamic occlusion and collapse of the true lumen. Progression of the dissection into the SMA is a life threatening condition and adjunct stenting becomes mandatory
Objective: Diffusely diseased left anterior descending (LAD) coronary artery is not uncommon finding in coronary angiography (CA), and its revascularization is a big challenge for cardiologists. Surgical patch reconstruction may be a useful option. The aim of the work is to assess clinical outcomes of surgical patch reconstruction of diffusely diseased LAD in comparison to multiple stenting. Methods: During the period from April 2009 and 2011; ninety patients with CA finding of diffusely diseased LAD coronary artery were managed by surgical on-lay patch reconstruction utilizing the left internal mammary artery (30 patients; group 1) if associated with significant left main (LM) disease and/or other graftable vessels in setting of preserved left ventricular ejection fraction (LVEF). Sixty patients (group 2) were managed by multiple LAD stenting. The results of both lines of management were analyzed retrospectively. Results: There was significant higher incidence of diabetes mellitus, LM disease, better average LVEF, prolonged intensive care unit (ICU) and hospital stay in (surgical group 1); (90% vs 60%; p < 0.03, 60% vs 5%; p < 0.01, 54±4% vs 48±4%; p < 0.05, 3±1 vs 1.5±0.5 days; p < 0.04 and 7±1.5 vs 2±1.6 days; p < 0.03 respectively). No operative or in-hospital mortality in (group 1). One patient in (group 2) died on third post procedure day due to contrast induced acute renal failure (p= NS). In-hospital acute myocardial infarction occurred in 1 patient in group1 and 2 patients in group 2, (p=NS). One patient in each group had late embolic cerebrovascular stroke (p=NS). Six patients in group 2 had late CA for recurrent ischemia and 2 of them had coronary artery bypass graft revascularization; while none of group 1 had late repeat revascularization. The average LVEF and New York Heart Association functional class were improved in the two groups with no late cardiac death. Conclusions: In the setting of diffusely diseased LAD, surgical patch reconstruction in selected patients is as safe and effective as multiple stenting with significant increase in ICU and hospital stay, but with less need for repeat revascularization. OP-315 SHORT-TERM OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY IN END STAGE RENAL FAILURE DIALYSIS-DEPENDENT PATIENTS A.I. Rezk. King Fahad Military Hospital, Riyadh, Saudi Arabia Objective: Patients with end-stage renal disease (ESRD) requiring dialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative morbidity and mortality. We describe our own experience in such high risk subgroup of patients.
Oral Presentations / International Journal of Cardiology 155S1 (2012) S1–S89
very useful diagnostic tools for recongize graft associated fatal complications. MDCT may offer detailed anatomic and functional data in these patients.
to preserve its patency. When SMA stenting fails, open bypass from the descending aorta and iliac arteries is problematic and dangerous because of the dissected fragile wall. Using the ascending aorta as an inflow might be a safe and valuable alternative to restore flow to the SMA. Conclusions: Exotic surgical bypasses like AA to SMA in a special setting such as type B dissection is a valid alternative when other traditional measures fail or becomes technically impossible. Saturday, 3 March 2012
17:00–18:30
Challenges in Surgical Treatment of Coronary Artery Disease OP-310 COMPARISON BETWEEN SURGICAL PATCH RECONSTRUCTION AND MULTIPLE STENTING INDIFFUSELY DISEASED LEFT ANTERIOR DESCENDING CORONARY ARTERY G.A. El Attar1 , M.A. El Anwar2 , A.M. Ibrahim3 , M.H. Abdou Allam4 . 1 Department of Cardiology, Suez Canal University, Ismailia, Egypt; 2 Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt; 3 Department of Cardiology, Ain Shams University, Cairo, Egypt; 4 Department of Cardiology, National Heart Institute, Cairo, Egypt
Figure 1.
Saturday, 3 March 2012
15:30–17:00
Interventions in Peripheral Arterial Diseases OP-307 AN UNUSUAL TECHNIQUE FOR SUPERIOR MESENTERIC ARTERY REVASCULARIZATION Y. Zorman, G. Gemayel, D. Mugnai, P. Mootoosamy, N. Murith, A. Kalangos. Department of Cardiovascular Surgery, University Hospital of Geneva, Switzerland Objective: Endovascular surgery became the mainstay of superior mesenteric artery (SMA) revascularization. When it is not technically feasible, different surgical options exist and classically consist of a retrograde or an antegrade bypass from the distal and the supracoeliac aorta respectively. We describe an unusual technique of SMA bypass using the ascending aorta as inflow. Methods: A 47 year old female was admitted to our hospital for a complicated type B aortic dissection with dynamic ischemia of the visceral renal arteries. She underwent an urgent endovascular fenestration to expand her collapsed true lumen but subsequently developed acute thrombosis of the SMA. After an initial failed attempt to stent the SMA, an urgent ascending aorta (AA) to SMA bypass was successfully performed using an ePTFE graft. The choice of the proximal anastomosis on the AA was dictated mainly by the absence of an adequate more distal site in a frail dissected wall of the whole descending aorta reaching both external iliac arteries. The patient did well and was discharged from the hospital at day 21 with a patent graft. Results: While stent graft placement is the treatment of choice of complicated type B dissection, endovascular aortic fenestration is a valid second alternative specially in dynamic occlusion and collapse of the true lumen. Progression of the dissection into the SMA is a life threatening condition and adjunct stenting becomes mandatory
Objective: Diffusely diseased left anterior descending (LAD) coronary artery is not uncommon finding in coronary angiography (CA), and its revascularization is a big challenge for cardiologists. Surgical patch reconstruction may be a useful option. The aim of the work is to assess clinical outcomes of surgical patch reconstruction of diffusely diseased LAD in comparison to multiple stenting. Methods: During the period from April 2009 and 2011; ninety patients with CA finding of diffusely diseased LAD coronary artery were managed by surgical on-lay patch reconstruction utilizing the left internal mammary artery (30 patients; group 1) if associated with significant left main (LM) disease and/or other graftable vessels in setting of preserved left ventricular ejection fraction (LVEF). Sixty patients (group 2) were managed by multiple LAD stenting. The results of both lines of management were analyzed retrospectively. Results: There was significant higher incidence of diabetes mellitus, LM disease, better average LVEF, prolonged intensive care unit (ICU) and hospital stay in (surgical group 1); (90% vs 60%; p < 0.03, 60% vs 5%; p < 0.01, 54±4% vs 48±4%; p < 0.05, 3±1 vs 1.5±0.5 days; p < 0.04 and 7±1.5 vs 2±1.6 days; p < 0.03 respectively). No operative or in-hospital mortality in (group 1). One patient in (group 2) died on third post procedure day due to contrast induced acute renal failure (p= NS). In-hospital acute myocardial infarction occurred in 1 patient in group1 and 2 patients in group 2, (p=NS). One patient in each group had late embolic cerebrovascular stroke (p=NS). Six patients in group 2 had late CA for recurrent ischemia and 2 of them had coronary artery bypass graft revascularization; while none of group 1 had late repeat revascularization. The average LVEF and New York Heart Association functional class were improved in the two groups with no late cardiac death. Conclusions: In the setting of diffusely diseased LAD, surgical patch reconstruction in selected patients is as safe and effective as multiple stenting with significant increase in ICU and hospital stay, but with less need for repeat revascularization. OP-315 SHORT-TERM OUTCOME OF CORONARY ARTERY BYPASS GRAFT SURGERY IN END STAGE RENAL FAILURE DIALYSIS-DEPENDENT PATIENTS A.I. Rezk. King Fahad Military Hospital, Riyadh, Saudi Arabia Objective: Patients with end-stage renal disease (ESRD) requiring dialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative morbidity and mortality. We describe our own experience in such high risk subgroup of patients.