delivery-cardioactive-therapeutics-porcine-myocardial-infarction

Delivery of Cardioactive Therapeutics in a Porcine Myocardial Infarction Model

Myocardial infarction is one of the leading causes of death and disability worldwide, and there is an urgent need for novel cardioprotective or ...

The University of Sydney

Composite arterial grafts using a T configuration from the left internal mammary artery (LIMA) are commonly used for coronary artery surgery. Little data exist regarding the use of saphenous vein (SV) in composite grafts from the LIMA. This study aimed to determine whether LIMA patency was reduced by the attachment of a SV T graft.

Mammary artery to saphenous vein composite T grafts for coronary artery bypass: late follow-up.

Internal mammary artery (IMA) grafts provide equal or superior graft patency compared to other conduits. The IMA length limits extensive myocardial revascularisation with IMA grafts alone. This study aimed to determine the results of lengthening free IMAs with a short proximal segment of saphenous vein (SV) to enable more extensive myocardial revascularisation.

Saphenous vein to internal mammary artery end-to-end composite grafts for coronary artery bypass. Late follow-up.

The use of bilateral internal thoracic arteries (BITA) in coronary artery bypass graft surgery improves patient survival. The optimum BITA graft configuration is unknown. This study evaluates outcomes after the use of bilateral internal mammary Y grafting as the primary grafting strategy.

Bilateral Internal Thoracic Artery Composite Y Grafts: Analysis of 464 Angiograms in 296 Patients.

The Definition of "Urgent" in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database.

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.

Composite Y-Grafting Using the Left Internal Thoracic Artery: Survival and Angiography in 198 Cases.

Competitive flow in coronary bypass surgery: The roles of fractional flow reserve and arterial graft configuration.

The use of composite coronary artery bypass grafts from the left internal mammary artery (LIMA) has increased over the last 20 years. Total arterial revascularisation can be achieved with two arterial conduits and is associated with a reduced risk of stroke. However, the traditional coronary bypass graft configurations of the in situ LIMA and aorto-coronary saphenous vein grafts remain as the mainstay of coronary bypass surgery in most centres. Concerns regarding composite Y grafts relate to (1) the adequacy of a single inflow for all coronary bypass grafts; (2) the risk of compromising the LIMA flow to the left anterior descending coronary artery; (3) the effects of competitive flow on graft patency; and (4) the use of sequential coronary anastomoses. The evidence upon which these concerns are based will be discussed along with the evidence relating to the use of the various second conduit options.

Composite Y Grafts From the Left Internal Mammary Artery: Current Considerations.

Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.

Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.

Publisher Correction: Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.

Transcatheter mitral valve prostheses are designed to capture the anterior leaflet and surgical techniques designed to fully preserve the subvalvular apparatus at prosthetic valve insertion both serve to shorten the anterior mitral leaflet height, thus effectively incorporating it into the anterior annulus. This study quantifies the acute effects of incorporating the anterior mitral leaflet into the annulus on left ventricular function.

Incorporating the anterior mitral leaflet to the annulus impairs left ventricular function in an ovine model.

Incorporating the anterior mitral leaflet to the annulus abolishes leaflet movement, the diastolic baffle effect, and shortens the long axis of the ventricle.

The anterior mitral leaflet (AML) contributes to left ventricular (LV) function but is normally excised at the time of a bioprosthetic valve insertion. This study aimed to investigate methods of safely retaining the AML at the time of mitral valve replacement.

Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction.

During mitral valve replacement, the anterior mitral leaflet is usually resected or modified. Anterior leaflet splitting seems the least disruptive modification. Reattachment of the modified leaflet to the annulus reduces the annulopapillary distance. The goal of this study was to quantify the acute effects on left ventricular function of splitting the anterior mitral leaflet and shortening the annulopapillary distance.

Article	Year
Mammary artery to saphenous vein composite T grafts for coronary artery bypass: late follow-up. The Journal of cardiovascular surgery\| PubMed ID: 24013541	2013
Saphenous vein to internal mammary artery end-to-end composite grafts for coronary artery bypass. Late follow-up. Heart, lung & circulation\| PubMed ID: 25456502	2015
Bilateral Internal Thoracic Artery Composite Y Grafts: Analysis of 464 Angiograms in 296 Patients. The Annals of thoracic surgery\| PubMed ID: 26507423	2016
The Definition of "Urgent" in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database. Heart, lung & circulation\| PubMed ID: 27160369	2016
Composite Y-Grafting Using the Left Internal Thoracic Artery: Survival and Angiography in 198 Cases. Heart, lung & circulation\| PubMed ID: 28117146	2017
Competitive flow in coronary bypass surgery: The roles of fractional flow reserve and arterial graft configuration. The Journal of thoracic and cardiovascular surgery\| PubMed ID: 28651939	2017
Composite Y Grafts From the Left Internal Mammary Artery: Current Considerations. Heart, lung & circulation\| PubMed ID: 29126818	2018
Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography. Scientific reports\| PubMed ID: 33060679	2020
Publisher Correction: Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography. Scientific reports\| PubMed ID: 33633120	2021
Incorporating the anterior mitral leaflet to the annulus impairs left ventricular function in an ovine model. JTCVS open\| PubMed ID: 36003711	2021
Incorporating the anterior mitral leaflet to the annulus abolishes leaflet movement, the diastolic baffle effect, and shortens the long axis of the ventricle. JTCVS open\| PubMed ID: 36004076	2021
Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction. JTCVS open\| PubMed ID: 36004084	2021
Splitting the anterior mitral leaflet impairs left ventricular function in an ovine model. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery\| PubMed ID: 36440952	2022

Hugh Paterson

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