He Arterial Grafting for Coronary Artery Bypass Surgery

2. Auflage 2006
ISBN: 978-3-540-30084-7
Verlag: Springer Berlin Heidelberg
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 356 Seiten

Autoren/Hrsg.

He, Guo-Wei

Inhaltsverzeichnis

1;Foreword;6
2;Preface;7
3;Contents;9
4;List of Contributors;15
5;I Biological Characteristics of Arterial Grafts;18
5.1;Histology and Comparison of Arterial Grafts Used for Coronary Surgery;19
5.1.1;1.1;19
5.1.2;Internal Mammary Artery;19
5.1.3;1.2;23
5.1.4;Right Gastroepiploic Artery;23
5.1.5;1.3;24
5.1.6;Inferior Epigastric Artery;24
5.1.7;1.4;25
5.1.8;Radial Artery;25
5.1.9;1.5;26
5.1.10;Intercostal Artery;26
5.1.11;1.6;27
5.1.12;Comment;27
5.1.13;References;30
5.2;Endothelial Function and Interaction Between the Endothelium and Smooth Muscle in Arterial Grafts;33
5.2.1;2.1;33
5.2.2;Endothelium-Derived Relaxing Factors;33
5.2.3;2.2;33
5.2.4;Endothelium-Derived Contracting Factors;33
5.2.5;2.3;33
5.2.6;Vasoconstrictors and Vasospasm in Arterial;33
5.2.7;Grafts;33
5.2.8;2.4;35
5.2.9;Vasoconstrictor-Stimulated EDRF Release;35
5.2.10;in Arterial Grafts;35
5.2.11;2.5;36
5.2.12;Endothelium-Dependent Relaxation;36
5.2.13;and Hyperpolarization in Arterial Grafts;36
5.2.14;2.6;37
5.2.15;The Balance Between EDRFs and EDCFs;37
5.2.16;References;38
5.3;Clinical Physiology and Related Biological Characteristics;40
5.3.1;3.1;40
5.3.2;Differences in Biological Characteristics;40
5.3.3;Between Venous and Arterial Grafts;40
5.3.4;3.2;40
5.3.5;Are There Any Differences Among Arterial;40
5.3.6;Grafts?;40
5.3.7;3.3;41
5.3.8;Biological Characteristics;41
5.3.9;References;45
5.4;Clinical Classification of Arterial Grafts;47
5.4.1;4.1;47
5.4.2;Introduction;47
5.4.3;4.2;47
5.4.4;Clinical Classification;47
5.4.5;References;50
6;II Use of Vasodilators for Arterial Grafts in Coronary Bypass Surgery;52
6.1;Pharmacological Studies and Guidelines for the Use of Vasodilators for Arterial Grafts;53
6.1.1;5.1;53
6.1.2;Pharmacological Studies;53
6.1.3;5.2;56
6.1.4;Factors Determining the Effects of Vasodilator;56
6.1.5;Substances;56
6.1.6;5.3;58
6.1.7;Guidelines for the Use of Vasodilators;58
6.1.8;for Arterial Grafts in CABG;58
6.1.9;References;58
7;III Myocardial Protection During Coronary Bypass Surgery Using Arterial Grafts;62
7.1;Myocardial Management in Arterial Revascularization;63
7.1.1;6.1;63
7.1.2;Cardioplegic Prerequisites;63
7.1.3;6.2;64
7.1.4;Cardioplegic Composition;64
7.1.5;6.3;64
7.1.6;Blood Cardioplegia ( Table 6.3);64
7.1.7;6.4;65
7.1.8;Operative Strategy;65
7.1.9;6.5;69
7.1.10;Cardioplegia Pressure;69
7.1.11;6.6;69
7.1.12;Retrograde Cardioplegia;69
7.1.13;6.7;71
7.1.14;Specific Issues with all Arterial Conduits;71
7.1.15;6.8;71
7.1.16;Reperfusion;71
7.1.17;6.9;72
7.1.18;Topical Hypothermia;72
7.1.19;6.10;73
7.1.20;Conclusions;73
7.1.21;References;73
7.2;Cardiac Protection from the Viewpoint of Coronary Endothelial Function;75
7.2.1;7.1;76
7.2.2;Possible Mechanisms Underlying the Damage;76
7.2.3;of Cardioplegia and Organ Preservation;76
7.2.4;on Endothelial Function;76
7.2.5;7.2;77
7.2.6;Influence of Cardioplegic and Organ;77
7.2.7;Preservation Solutions on Individual EDRFs;77
7.2.8;7.3;77
7.2.9;Influence of Different Components in;77
7.2.10;Cardioplegic and Organ Preservation Solutions;77
7.2.11;on Endothelial Function;77
7.2.12;7.4;78
7.2.13;Effect of Different Additives to Cardioplegic;78
7.2.14;or Organ Preservation Solutions on Endothelial;78
7.2.15;Function;78
7.2.16;References;80
8;IV Percutaneous Coronary Interventions Versus Coronary Artery Bypass Surgery;83
8.1;Needle or Knife? A Comparison Between Percutaneous Coronary Interventions ( Including Plain Balloon Angioplasty and Coronary Stenting) and Coronary Artery Bypass Surgery;84
8.1.1;8.1;84
8.1.2;Introduction;84
8.1.3;8.2;84
8.1.4;Percutaneous Coronary Interventions;84
8.1.5;8.3;84
8.1.6;Coronary Artery Bypass Grafting;84
8.1.7;8.4;85
8.1.8;PCI Versus CABG;85
8.1.9;8.5;86
8.1.10;Drug Eluting Stents;86
8.1.11;8.6;87
8.1.12;Revascularization Strategy;87
8.1.13;References;87
9;V Clinical Choice of Arterial Grafts;89
9.1;Considerations in the Choice of Arterial Grafts;90
9.1.1;9.1;91
9.1.2;General Condition of the Patient;91
9.1.3;9.2;91
9.1.4;Biological Characteristics;91
9.1.5;9.3;93
9.1.6;Anatomy of the Coronary Artery;93
9.1.7;9.4;93
9.1.8;Vessel Match Between the Graft and the;93
9.1.9;Coronary Artery;93
9.1.10;9.5;93
9.1.11;Technical Considerations;93
9.1.12;9.6;93
9.1.13;Conclusion;93
9.1.14;References;93
10;VI Internal Thoracic Artery Grafting;96
10.1;History of Internal Thoracic Artery Grafting and Alternative Arterial Grafts;97
10.1.1;10.1;98
10.1.2;Early Direct Arterial Revascularization;98
10.1.3;Techniques;98
10.1.4;10.2;99
10.1.5;Coronary Arteriography;99
10.1.6;10.3;100
10.1.7;Saphenous Vein Coronary Artery Bypass;100
10.1.8;10.4;100
10.1.9;Internal Thoracic Artery Grafting;100
10.1.10;10.5;100
10.1.11;Expanded Use of the ITA Graft;100
10.1.12;10.6;101
10.1.13;Alternative Arterial Grafts;101
10.1.14;10.7;101
10.1.15;ITA Grafts and Minimally Invasive Coronary;101
10.1.16;Artery Bypass Grafting;101
10.1.17;10.8;101
10.1.18;The Future;101
10.1.19;References;102
10.2;Surgical Techniques for Internal Thoracic Artery Grafting;105
10.2.1;11.1;105
10.2.2;Introduction;105
10.2.3;11.2;105
10.2.4;Anatomy;105
10.2.5;11.3;105
10.2.6;Harvesting;105
10.2.7;11.4;108
10.2.8;Histology;108
10.2.9;11.5;108
10.2.10;Goals of Arterial Grafting;108
10.2.11;11.6;109
10.2.12;Grafting Strategy;109
10.2.13;11.7;109
10.2.14;Grafting Techniques;109
10.2.15;11.8;111
10.2.16;Beating Heart Bypass Surgery;111
10.2.17;11.9;111
10.2.18;Less Invasive Surgical Techniques;111
10.2.19;11.10;112
10.2.20;Conclusions;112
10.2.21;References;112
10.3;Long- Term Results of Internal Thoracic Artery Grafting;113
10.3.1;12.1;113
10.3.2;Introduction;113
10.3.3;12.2;113
10.3.4;History;113
10.3.5;12.3;113
10.3.6;Patency;113
10.3.7;12.4;115
10.3.8;Survival;115
10.3.9;12.5;117
10.3.10;Freedom from Recurrent Ischemic Events;117
10.3.11;12.6;118
10.3.12;Conclusions;118
10.3.13;References;118
10.4;Bilateral Versus Unilateral Internal Thoracic Artery in Coronary Bypass Grafting;121
10.4.1;13.1;121
10.4.2;Introduction;121
10.4.3;13.2;121
10.4.4;History;121
10.4.5;13.3;121
10.4.6;Indications for Use of Bilateral ITAs;121
10.4.7;13.4;122
10.4.8;Relative Contraindications;122
10.4.9;13.5;122
10.4.10;Early Mortality;122
10.4.11;13.6;123
10.4.12;Myocardial Infarction;123
10.4.13;13.7;127
10.4.14;Late Results;127
10.4.15;13.8;131
10.4.16;Postoperative Flow Measurements;131
10.4.17;13.9;131
10.4.18;Late ECG-Stress Testing;131
10.4.19;13.10;131
10.4.20;Late Blood Flow Studies;131
10.4.21;13.11;132
10.4.22;Late Patency Rates;132
10.4.23;13.12;133
10.4.24;Conclusions;133
10.4.25;References;133
10.5;Left- Sided Myocardial Revascularization with Bilateral Skeletonized Internal Thoracic Artery;138
10.5.1;14.1;138
10.5.2;Introduction;138
10.5.3;14.2;139
10.5.4;Harvesting and Preparation of the Skeletonized;139
10.5.5;ITA [16];139
10.5.6;14.3;140
10.5.7;Strategies of Left-Sided Arterial;140
10.5.8;Revascularization;140
10.5.9;14.4;145
10.5.10;Clinical Results [35, 36];145
10.5.11;14.5;145
10.5.12;Comments;145
10.5.13;References;146
10.6;Free Compared with Pedicled Right Internal Thoracic Arteries for Coronary Artery Bypass Grafting;148
10.6.1;15.1;148
10.6.2;Introduction;148
10.6.3;15.2;148
10.6.4;Materials and Methods;148
10.6.5;15.3;149
10.6.6;Indications;149
10.6.7;15.4;149
10.6.8;Surgical Technique;149
10.6.9;15.5;151
10.6.10;Follow-up;151
10.6.11;15.6;151
10.6.12;Results;151
10.6.13;15.7;152
10.6.14;Discussion;152
10.6.15;15.8;154
10.6.16;Conclusion;154
10.6.17;References;154
11;VII Radial Artery Grafting;156
11.1;History and Operative Technique;157
11.1.1;16.1;157
11.1.2;History;157
11.1.3;16.2;157
11.1.4;Preoperative Assessment;157
11.1.5;16.3;159
11.1.6;Operative Technique;159
11.1.7;References;161
11.2;Radial Artery Grafting: Clinical Antispastic Protocols;162
11.2.1;17.1;163
11.2.2;GWH Protocol (Previously University of Hong;163
11.2.3;Kong Protocol);163
11.2.4;17.2;166
11.2.5;Discussion;166
11.2.6;References;168
11.3;Radial Artery: Clinical Results;171
11.3.1;18.1;171
11.3.2;Early Results;171
11.3.3;18.2;172
11.3.4;Late Results;172
11.3.5;18.3;175
11.3.6;Conclusion;175
11.3.7;References;175
11.4;Angiographic Studies of the Radial Artery Graft;177
11.4.1;19.1;177
11.4.2;Introduction;177
11.4.3;19.2;177
11.4.4;Patients and Methods;177
11.4.5;19.3;177
11.4.6;Surgical Technique;177
11.4.7;19.4;178
11.4.8;Results;178
11.4.9;19.5;178
11.4.10;Angiographic Studies;178
11.4.11;19.6;180
11.4.12;Discussion;180
11.4.13;References;182
12;VIII Gastroepiploic Artery Grafting;184
12.1;Right Gastroepiploic Artery Grafting: History and Operative Techniques;185
12.1.1;20.1;185
12.1.2;Introduction;185
12.1.3;20.2;185
12.1.4;Anatomy;185
12.1.5;20.3;185
12.1.6;History;185
12.1.7;20.4;188
12.1.8;Harvesting Technique;188
12.1.9;20.5;191
12.1.10;Preparation of the Artery 20.6;191
12.1.11;Routing the Pedicle;191
12.1.12;20.7;192
12.1.13;Anastomotic Technique;192
12.1.14;20.8;195
12.1.15;Perioperative Management;195
12.1.16;20.9;195
12.1.17;Conclusion;195
12.1.18;References;195
12.2;The Right Gastroepiploic Artery Graft;197
12.2.1;21.1;197
12.2.2;Introduction;197
12.2.3;21.2;197
12.2.4;Clinical Results;197
12.2.5;References;199
12.3;Technique and Results for Skeletonized GEA Using the Harmonic Scalpel in Combination with Other Arterial Grafts in Off- Pump Coronary Bypass Surgery;200
12.3.1;22.1;200
12.3.2;History of GEA Skeletonization;200
12.3.3;22.2;201
12.3.4;A Technique for Skeletonizing GEA Using;201
12.3.5;the Harmonic Scalpel;201
12.3.6;22.3;203
12.3.7;Results of Skeletonized GEA in Combination;203
12.3.8;with Skeletonized IMA in OPCAB;203
12.3.9;22.4;204
12.3.10;Comments;204
12.3.11;References;204
13;IX Inferior Epigastric Artery Grafting;205
13.1;Inferior Epigastric Artery Grafting: History, Anatomy and Surgical Techniques;206
13.1.1;23.1;206
13.1.2;Historical Note;206
13.1.3;23.2;206
13.1.4;Inferior Epigastric Artery;206
13.1.5;23.3;206
13.1.6;Anatomy of the Epigastric Artery;206
13.1.7;23.4;207
13.1.8;Surgical Technique;207
13.1.9;23.5;209
13.1.10;Postoperative Angiography;209
13.1.11;23.6;209
13.1.12;Remodeling of the IEA;209
13.1.13;23.7;210
13.1.14;Clinical Experience;210
13.1.15;References;210
13.2;Inferior Epigastric Artery Grafting: Clinical Results;211
13.2.1;24.1;211
13.2.2;Introduction;211
13.2.3;24.2;211
13.2.4;Indications, Perioperative Mortality and;211
13.2.5;Myocardial Infarction Rate;211
13.2.6;24.3;211
13.2.7;Morbidity Related to IEA Harvesting;211
13.2.8;24.4;212
13.2.9;Patency Rates;212
13.2.10;24.5;213
13.2.11;Composite Grafts Using the IEA;213
13.2.12;24.6;213
13.2.13;Conclusion;213
13.2.14;References;214
14;X Rarely or Possibly Used Arterial Grafting;215
14.1;Splenic Artery Grafting;216
14.1.1;25.1;216
14.1.2;Case Report;216
14.1.3;25.2;216
14.1.4;Technique;216
14.1.5;25.3;217
14.1.6;Use of the Splenic Artery Under Other;217
14.1.7;Situations;217
14.1.8;25.4;218
14.1.9;Discussion;218
14.1.10;25.5;218
14.1.11;Conclusion;218
14.1.12;References;218
14.2;Use of the Subscapular- Thoracodorsal Artery for Coronary Artery Bypass Grafting;219
14.2.1;26.1;219
14.2.2;Anatomical Notes;219
14.2.3;26.2;219
14.2.4;Historic Notes;219
14.2.5;26.3;220
14.2.6;Harvest of the Subscapular Artery;220
14.2.7;26.4;221
14.2.8;Cannulation;221
14.2.9;26.5;221
14.2.10;Clinical Notes;221
14.2.11;26.6;222
14.2.12;Comment;222
14.2.13;References;223
14.3;Inferior Mesenteric Artery Grafting;224
14.3.1;Update Note by the Editor;224
14.3.2;27.1;224
14.3.3;Introduction and Anatomic Considerations;224
14.3.4;27.2;225
14.3.5;Physiopathologic Considerations;225
14.3.6;27.3;226
14.3.7;Harvesting of Inferior Mesenteric Artery;226
14.3.8;27.4;227
14.3.9;Clinical Experience;227
14.3.10;27.5;227
14.3.11;Closing Comments;227
14.3.12;References;227
14.4;Ulnar Artery as a Coronary Artery Bypass Graft: Five- Year Experience;228
14.4.1;28.1;228
14.4.2;Introduction;228
14.4.3;28.2;228
14.4.4;Anatomy;228
14.4.5;28.3;229
14.4.6;Patterns of Arterial Supply to the Forearm;229
14.4.7;and Hand;229
14.4.8;28.4;229
14.4.9;Surgical Technique;229
14.4.10;28.5;231
14.4.11;Results;231
14.4.12;28.6;232
14.4.13;Discussion;232
14.4.14;References;233
14.5;Descending Branch of Lateral Circumflex Femoral Artery Grafting;234
14.5.1;29.1;234
14.5.2;Introduction;234
14.5.3;29.2;234
14.5.4;Anatomy;234
14.5.5;29.3;235
14.5.6;Surgical Procedure;235
14.5.7;29.4;235
14.5.8;Results;235
14.5.9;29.5;236
14.5.10;Comment;236
14.5.11;References;238
14.6;The Intercostal Artery: An “ Ideal” Arterial Graft Awaiting Clinical Application;239
14.6.1;30.1;239
14.6.2;History;239
14.6.3;30.2;239
14.6.4;Potential Advantages of Intercostal Arteries;239
14.6.5;30.3;240
14.6.6;Feasibility Studies;240
14.6.7;30.4;240
14.6.8;The Future;240
14.6.9;References;241
15;XI Arterial Grafting Using Complex Grafts;242
15.1;Complex Arterial Grafts: Operative Techniques;243
15.1.1;31.1;243
15.1.2;Internal Mammary Artery;243
15.1.3;31.2;245
15.1.4;Right Gastroepiploic Artery;245
15.1.5;31.3;245
15.1.6;Inferior Epigastric Artery and Radial Artery;245
15.1.7;31.4;245
15.1.8;Inferior Epigastric Artery;245
15.1.9;31.5;246
15.1.10;Radial Artery;246
15.1.11;References;246
15.2;Complex Arterial Grafts: Clinical Results;248
15.2.1;32.1;248
15.2.2;End-to-Side;248
15.2.3;32.2;248
15.2.4;End-to-End;248
15.2.5;32.3;248
15.2.6;End-to-Side/End-to-End;248
15.2.7;32.4;249
15.2.8;BIMA Y Graft;249
15.2.9;32.5;250
15.2.10;Radial Artery;250
15.2.11;32.6;252
15.2.12;Inferior Epigastric Artery;252
15.2.13;32.7;252
15.2.14;Conclusion;252
15.3;Internal Thoracic Artery T- Grafting: Operative Technique and Long- Term Results;253
15.3.1;33.1;253
15.3.2;Introduction;253
15.3.3;33.2;253
15.3.4;Developments Leading to T-Graft Technique;253
15.3.5;33.3;253
15.3.6;Advantages of ITA Grafts;253
15.3.7;33.4;254
15.3.8;Operative Technique;254
15.3.9;33.5;256
15.3.10;Failure of ITA Grafts;256
15.3.11;33.6;257
15.3.12;Demographics of T-Graft Patients;257
15.3.13;33.7;257
15.3.14;Results;257
15.3.15;33.8;259
15.3.16;Comparison of Results;259
15.3.17;33.9;259
15.3.18;Comment;259
15.3.19;References;260
15.4;Internal Thoracic Artery and Radial Artery T- Grafting: Operative Technique and Long- Term Results;261
15.4.1;34.1;261
15.4.2;Radial Artery;261
15.4.3;34.2;261
15.4.4;Technique;261
15.4.5;34.3;263
15.4.6;Harvest Complications;263
15.4.7;34.4;263
15.4.8;Hypoperfusion;263
15.4.9;34.5;264
15.4.10;Results;264
15.4.11;34.6;264
15.4.12;Conduit Patency;264
15.4.13;34.7;264
15.4.14;Conclusions;264
15.4.15;References;265
16;XII Arterial Grafting in Reoperative Coronary Artery Bypass Surgery;266
16.1;Role of Internal Thoracic Artery Grafts in Reoperative Coronary Artery Bypass Surgery;267
16.1.1;35.1;267
16.1.2;Introduction;267
16.1.3;35.2;267
16.1.4;Perioperative Risk of Internal Thoracic Artery;267
16.1.5;Grafting at Reoperation;267
16.1.6;35.3;269
16.1.7;Impact of Patent Internal Thoracic Artery Grafts;269
16.1.8;on Perioperative Risk;269
16.1.9;35.4;271
16.1.10;Internal Thoracic Artery Grafts and Survival;271
16.1.11;after Coronary Reoperation;271
16.1.12;35.5;272
16.1.13;Conclusions;272
16.1.14;References;272
17;XIII Quality Control of Arterial Grafting: Early Detection of Graft Patency and Flow;274
17.1;Flow Capacity of Arterial Grafts: Internal Thoracic Artery, Gastroepiploic Artery and Other Grafts;275
17.1.1;36.1;275
17.1.2;Internal Thoracic Arteries;275
17.1.3;36.2;275
17.1.4;Studies of Flow Reserve of the ITA;275
17.1.5;36.3;276
17.1.6;Effect of Competitive Flow on the ITA;276
17.1.7;and Remodeling;276
17.1.8;36.4;276
17.1.9;Capability of ITA to Respond to Flow Demand;276
17.1.10;36.5;277
17.1.11;Effect of Skeletonization on the Flow Capacity;277
17.1.12;of the ITA;277
17.1.13;36.6;277
17.1.14;Right Gastroepiploic Artery;277
17.1.15;36.7;277
17.1.16;Pressure Characteristics of GEA;277
17.1.17;36.8;277
17.1.18;Adequate Size of the GEA as a Graft;277
17.1.19;36.9;279
17.1.20;Effect of Skeletonization on the Flow Capacity;279
17.1.21;of the GEA;279
17.1.22;References;279
17.2;Intraoperative Graft Evaluation in Coronary Artery Bypass Grafting Using a 15- MHz High- Frequency Linear Transducer: Maintaining the Comprehensive Quality of Coronary Surgery;281
17.2.1;37.1;281
17.2.2;Routine Evaluation of Graft, Artery;281
17.2.3;and Anastomosis;281
17.2.4;37.2;282
17.2.5;Troubleshooting with Anastomosis in OPCAB;282
17.2.6;37.3;282
17.2.7;Revascularization of Intramuscular Coronary;282
17.2.8;Artery in OPCAB;282
17.2.9;References;284
18;XIV Role of Venous Grafts in Arterial Grafting;285
18.1;Role of Venous Grafts in Combination with Arterial Grafting;286
18.1.1;38.1;286
18.1.2;Introduction;286
18.1.3;38.2;286
18.1.4;Recent Reports on the Long-Term Patency;286
18.1.5;of SVG;286
18.1.6;38.3;287
18.1.7;Methods to Improve SVG Patency;287
18.1.8;38.4;288
18.1.9;Use of SVG in Combination with Arterial Grafts;288
18.1.10;38.5;288
18.1.11;Use of SVG in Minimally Invasive CABG;288
18.1.12;38.6;288
18.1.13;Surgical Strategy and Technique for the Use;288
18.1.14;of SVG;288
18.1.15;References;291
18.2;Minimally Invasive Saphenous Vein Harvesting for Coronary Artery Bypass Grafting;293
18.2.1;39.1;293
18.2.2;Introduction;293
18.2.3;39.2;293
18.2.4;Minimally Invasive Techniques for Saphenous;293
18.2.5;Vein Harvest;293
18.2.6;39.3;294
18.2.7;Limitations of Endoscopic Vein Harvest;294
18.2.8;39.4;296
18.2.9;Evolution and Technique of Endoscopic;296
18.2.10;Technique at Our Institution;296
18.2.11;39.5;296
18.2.12;Conclusion;296
18.2.13;References;297
18.3;Novel Strategies for the Prevention of Vein Graft Failure;298
18.3.1;40.1;298
18.3.2;Introduction;298
18.3.3;40.2;298
18.3.4;Mechanisms Underlying Neointima Formation,;298
18.3.5;Graft Thickening and Atherogenesis;298
18.3.6;40.3;300
18.3.7;External Dacron Stents and Biodegradable;300
18.3.8;Sheaths;300
18.3.9;40.4;301
18.3.10;Endothelin- 1A Antagonists;301
18.3.11;40.5;303
18.3.12;Nitroaspirin;303
18.3.13;40.6;303
18.3.14;Antioxidant Therapy;303
18.3.15;40.7;304
18.3.16;Concluding Remarks;304
18.3.17;References;304
18.4;Gene Therapy for Vein Graft Disease;306
18.4.1;41.1;306
18.4.2;Gene Therapy;306
18.4.3;41.2;307
18.4.4;Saphenous Vein Graft Disease;307
18.4.5;41.3;308
18.4.6;Vein Graft Gene Therapy;308
18.4.7;41.4;310
18.4.8;Candidate Genes;310
18.4.9;41.5;313
18.4.10;Future Directions;313
18.4.11;41.6;313
18.4.12;Conclusion;313
18.4.13;References;313
19;XV Minimally Invasive Techniques in Arterial Grafting;316
19.1;Minimally Invasive Coronary Artery Bypass Surgery and the Role of Arterial Conduits;317
19.1.1;42.1;317
19.1.2;MIDCAB Procedure;317
19.1.3;42.2;318
19.1.4;Minimally Invasive CAB (Port Access);318
19.1.5;42.3;318
19.1.6;Off-Pump Coronary Artery Bypass Grafting;318
19.1.7;(OPCAB);318
19.1.8;42.4;321
19.1.9;Multivessel Off-Pump Limited Access Surgery;321
19.1.10;42.5;321
19.1.11;Hybrid Procedure;321
19.1.12;42.6;321
19.1.13;Facilitating Technology for Minimally Invasive;321
19.1.14;Arterial Grafting;321
19.1.15;References;323
19.2;Off- Pump Coronary Artery Bypass Grafting Using Arterial Grafts;325
19.2.1;43.1;325
19.2.2;Extracorporeal Circulation;325
19.2.3;43.2;326
19.2.4;When Can Myocardial Revascularization;326
19.2.5;Without Extracorporeal Circulation Be Performed?;326
19.2.6;43.3;326
19.2.7;Arterial Grafts and Off-Pump Myocardial;326
19.2.8;Revascularization;326
19.2.9;43.4;327
19.2.10;Operative Technique;327
19.2.11;43.5;328
19.2.12;Clinical Experience;328
19.2.13;References;329
19.3;Comparison of the Effect of On- Pump and Off- Pump Coronary Artery Bypass Grafting on Neurological Events;331
19.3.1;44.1;331
19.3.2;Introduction;331
19.3.3;44.2;331
19.3.4;Stroke;331
19.3.5;44.3;332
19.3.6;Delirium;332
19.3.7;44.4;332
19.3.8;Cognitive Impairment;332
19.3.9;44.5;333
19.3.10;Conclusions;333
19.3.11;References;334
19.4;Closed- Chest Cardiopulmonary Bypass and Cardioplegia for Coronary Artery Bypass Surgery: History and Development;336
19.4.1;45.1;336
19.4.2;Introduction;336
19.4.3;45.2;336
19.4.4;History and Development;336
19.4.5;45.3;339
19.4.6;Closed-Chest Cardiac Surgery and Robotics;339
19.4.7;45.4;342
19.4.8;Conclusions;342
19.4.9;References;342
20;Subject Index;344