By Ludwig K. von Segesser M.D., F.A.C.S. (auth.)
With an enormous history of non-public event and a evaluation of greater than three hundred references, Dr. Segesser has written a e-book to shut the space among the speculation and perform of coronary artery revascularization. particularly, he exhibits the probabilities and boundaries of inner mammary artery grafting during this surgery. The chapters consultant you to an intensive realizing of the topic, from anatomy and pathology, to experimental experiences and the heritage of first surgical makes an attempt, to scientific software and effects. The dialogue of long term follow-up, problems and re-operations element to parts of luck in addition to matters for destiny study. the main points supplied the following approximately operative concepts and their results provide the cardiovascular surgical group very important suggestions approximately current practices with the intention to support result in better scientific effects.
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Additional info for Arterial Grafting for Myocardial Revascularization: Indications, Surgical Techniques and Results
Cohen et al. (1988) measured only 25 ± 17 ml/min for human retrointernal mammary arteries in comparison to 73 ± 34 ml/min for anterointernal mammary arteries. 4 Alternative Grafts for Coronary Artery Revascularization mammary artery (retrograde flow 34 % of anterograde flow) may be lower in comparison to other reports because the internal mammary arteries were transected only 5 mm above their bifutcation and were therefore supplied by only two collateral branches (see Fig. 8). The main indication for retrointernal mammary artery~coro nary artery anastomoses might be patients with severely diseased ascending aorta and 37 supraaortic vessels in combination with relatively distal coronary artery lesions.
2 Homologous Alternative Graft Materials Homologous saphenous veins, either tanned or sterilized with antibiotic solutions, have been utilized in peripheral vascular surgery with moderate success. Application of these graft materials in coronary artery revascularization has been performed sporadically. A more recent approach is the use of cryopreserved saphenous vein grafts for coronary artery revascularization (Tice et al. 1976; Gelbfish 1986) in the absence of another more suitable autologous graft material.
This includes endothelial cell seeding 40 5 Experimental Studies Fig. 32. Micrograph of a hybrid polyurethane graft with complete endothelial cell lining or lining, heparin-like biomaterials and heparin surface coating. The idea of heparin surface coating is not new. It was introduced by V. Gott in 1963 for the apicoaortic shunt which was applied clinically for the resection of aortic aneurysms without the need for systemic heparinization. In the meanwhile heparin surface coatings have been improved so far that open-chest cardiopulmonary bypass without systemic heparinization can be successfully realized in animal experiments (von Segesser and Turina 1989).
Arterial Grafting for Myocardial Revascularization: Indications, Surgical Techniques and Results by Ludwig K. von Segesser M.D., F.A.C.S. (auth.)