Effects of Skeletonized versus Pedicled Internal Thoracic Artery Grafts on Free Flow Capacity during Bypass

The free flow of skeletonized ITA grafts was compared with that of pedicled ITA grafts. One hundred patients with coronary artery diseases underwent elective CABG. In the group Ⅰ(n= 50), the left ITA was dissected using the skeletonization technique. In the group Ⅱ(n=50), the ITA was harvested as a pedicled graft. Free flow of the ITA was recorded before and 15 min after in- traluminal application of diluted papaverine. Mean arterial pressure was maintained at 9. 31 kPa (70 mmHg). The results showed that before the application of papaverine, free flow of skeletonized and pedicled ITA grafts was identical between the two groups. After treatment with papaverine, the maximum free flow was significantly higher in the skeletonized ITA's in the group Ⅰ(199. 3±69. 6 ml/min) than in the group Ⅱ(145. 7±70. 3 ml/min, P<0. 05). There was on significant differ- ence between the free flow after dilatation of the left and right ITA in the group Ⅰ (left 199. 3±69. 6 ml/mm, right 198. 9±61. 8 ml/mm, respectively). It was concluded that preparation of the ITA with the skeletonization technique resulted in significantly higher free flow capacity than in pedicled grafts and would improve the results of arterial revascularization. The complication rate seems to be lower than with the conventional method.

Efficacy and safety of transcatheter chemoembolization of the internal thoracic artery in patients with hepatocellular carcinoma

Background Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization （TACE）in patients with hepatocellular carcinoma （HCC）. We evaluated the efficacy and safety of TACE, and the prevention and management of complications among patients in whom the internal thoracic artery （ITA） was involved.Methods A total of 3614 cases of HCC were treated with 12 645 TACEs and 211 of these cases were given ITA angiography, including 156 cases of which the ITA was involved. We performed 562 TACEs in the 156 cases. We analyzed imaging examinations, types of embolization, and the incidence, prevention, and treatment of complications.Results The ITA was successfully embolized in 156 cases. Angiography of the ITA showed that the major trunks were thickened with an increased number of branching vessels, contributing to intrahepatic and extrahepatic tumor blood supply. Different embolization methods were selected according to the blood supply, to effectively embolize the tumor and mitigate or avoid serious complications. TACE with ITA embolization extended the mean interval time between two treatments from 2.54 months （1-17 months） to 4.23 months （1-30 months） compared with that without ITA embolization.The ITA supplied the HCC in the following instances： HCC was located in the ventral hepatic area and abutted the diaphragm （P=0.0064） and repeated TACE （P=0.0003）. The survival rate of TACE with ITA embolization for HCC was better than TACE without ITA embolization （P ＜0.00001 ）.Conclusions In cases with massive HCC or nodular HCC, the ITA may be involved in supplying blood to the tumor.This occurs when the tumor is positioned in the ventral hepatic area and abuts the diaphragm （S2, S4, and S8）, and especially if cases have a previous history of TACE. In this case series, embolization was effective, extended the mean interval time of interventional therapy, and prolonged survival time.

Robotic internal thoracic artery harvesting： the learning curve and graft patency

Since the first report of totally endoscopic coronary artery bypass graft （CABG） using da Vinci SurgicalSystem （Intuitive Surgical, Sunnyvale, CA, USA） in 1999, the robotic technology has been applied to internal thoracic artery （ITA） harvesting for more than I0 years. We present the experience of robotic ITA skeletonized harvesting in 200 cases using the da Vinci S or da Vinci SI Surgical System. The learning curves of 1TA harvesting time and the results of ITA graft patency were evaluated.

A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery （ITA） grafting and Cooley＇s technique.