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Paul P Urbanski - One of the best experts on this subject based on the ideXlab platform.
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new vascular Graft for assembling the stentless valve Composite Graft
The Annals of Thoracic Surgery, 2007Co-Authors: Paul P UrbanskiAbstract:The use of a new vascular tube with an uncrimped section for assembling the stentless valve Composite Graft is described. The Graft simplifies the fixation of the valve within the tube because no stretching of the crimping is necessary to achieve optimal commissural height of the valve during sewing. Furthermore, this allows the Composite construction outside the chest and reduces the cross-clamp time.
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replacement of the aortic valve and ascending aorta with a valved stentless Composite Graft technical considerations and early clinical results
The Annals of Thoracic Surgery, 2000Co-Authors: Paul P Urbanski, Robert W HackerAbstract:Abstract Background . Replacement of the aortic valve and the ascending aorta with a conduit consisting of a mechanical valve and a Dacron tube has become a fairly common procedure. Commercially available conduits employing xenoGrafts are rarely used for the same purpose, because if a reoperation becomes necessary due to degeneration of the valve prosthesis, usually the entire conduit must be replaced. A Composite Graft with a stentless valve, such as we describe in this article, avoids this problem, because in case of reoperation only the valve cusps need to be resected and the tube Graft may be left in place. Methods . Surgical technique of replacement of the aortic valve and the ascending aorta with a stentless Composite Graft and early results of the procedure are presented. Results . Hemodynamics of the Graft soon after surgery were excellent, with an average systolic gradient of 8 mm Hg and no regurgitation across the valve. There were two reoperations for bleeding in the early postoperative period. Conclusions . The stentless Composite Graft we describe provides excellent hemodynamics, has no need for anticoagulation, and is expected to offer a benefit in case of reoperation.
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replacement of the ascending aorta and aortic valve with a valved stentless Composite Graft
The Annals of Thoracic Surgery, 1999Co-Authors: Paul P UrbanskiAbstract:A technique of total aortic root replacement with a stentless porcine Composite Graft is described. This Graft is assembled during surgery using a woven polyester vascular prosthesis and a stentless aortic bioprosthesis.
Ho Young Hwang - One of the best experts on this subject based on the ideXlab platform.
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saphenous vein versus right internal thoracic artery as a y Composite Graft five year angiographic and clinical results of a randomized trial
The Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Ho Young Hwang, Se Jin Oh, Myoung Jin JangAbstract:Abstract Objectives We compared the 5-year Graft occlusion rates and midterm clinical outcomes of saphenous vein Composite Grafts with those of right internal thoracic artery Composite Grafts in patients who were enrolled in the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite Graft trial. Methods Of 224 eligible patients with multivessel coronary artery disease who were randomized to undergo off-pump revascularization using the saphenous vein (saphenous vein group, n = 112) or right internal thoracic artery (right internal thoracic artery group, n = 112) as Y-Composite Grafts based on the in situ left internal thoracic artery from September 2008 to October 2011, 219 patients (saphenous vein group, n = 109; right internal thoracic artery group, n = 110) entered the analysis. A third limb conduit to lengthen the Graft limb for complete revascularization was used in 47 patients (saphenous vein group vs right internal thoracic artery group, 8 vs 39). Postoperative 5-year (61.7 ± 5.2 months) angiograms were performed in 186 patients (84.9%; saphenous vein group = 95; right internal thoracic artery group = 91). Follow-up was complete in 97.7% (214/219) of patients with a median follow-up of 80.7 months. Results The overall Graft occlusion rate was 3.6% at 5 years (3.5% in the saphenous vein group vs 3.7% in the right internal thoracic artery group, P = .910). The 5-year occlusion rate of the second limb conduits in the saphenous vein group was 4.3% and was noninferior to that of the right internal thoracic artery group (2.4%) within the 95% 2-sided confidence interval of −1.4% to 5.2% (P Conclusions The saphenous vein Composite Grafts were noninferior to the right internal thoracic artery Composite Grafts in terms of 5-year Graft occlusion rates and midterm clinical outcomes.
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Saphenous vein as a Composite Graft from the internal thoracic artery
Annals of cardiothoracic surgery, 2018Co-Authors: Ho Young Hwang, Ki Bong KimAbstract:The saphenous vein (SV) has been used as an aortocoronary bypass Graft for coronary artery bypass Grafting (CABG) for the past 50 years. However, CABG using the aortocoronary SV has shown disadvantages of lower long-term Graft patency rates and subsequently worse clinical outcomes, compared with CABG using the internal thoracic artery (ITA). The advantages of CABG using the ITA prompted interest in total arterial revascularization, using the bilateral ITAs and other arterial conduits as Composite Graft configurations in patients exhibiting multi-vessel disease. Total arterial revascularization using a Y- or T-Composite Graft based on the in situ ITA increases the length of the arterial Graft and allows the extensive use of arterial conduits to revascularize both the left and right coronary territories. Further, it has demonstrated favorable outcomes in terms of angiographic patency rates, myocardial perfusion and thickening by single photon emission computed tomography, and long-term clinical outcomes. However, previous studies describing the use of the SV conduit as a Composite Graft have produced conflicting results. In this article, a recent surgical strategy of using the SV as part of a Composite Graft based on the in situ left ITA will be discussed.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y Composite Graft save rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ki Bong Kim, Ho Young Hwang, Seokyung Hahn, Jun Sung KimAbstract:Objective The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-Composite Graft. Methods A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or RITA as a Y-Composite Graft based on the in situ left ITA were assigned randomly to the SV Y-Composite Graft (SV group, n = 112) or free RITA Y-Composite Graft (RITA group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or RITA). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; RITA group, 107). Results The overall Graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the RITA group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV Composite Grafts, was 97.1% (238 of 245) and was noninferior to that of the RITA Composite Grafts (97.1% [198 of 204]) with a 95% lower confidence limit of −2.6% ( P P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years ( P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years ( P = .597). Conclusions The SV Composite Grafts were noninferior to the RITA Composite Grafts in terms of the 1-year angiographic patency rates.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y Composite Graft save rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ho Young Hwang, Seokyung Hahn, Se Jin OhAbstract:OBJECTIVE: The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-Composite Graft. METHODS: A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or RITA as a Y-Composite Graft based on the in situ left ITA were assigned randomly to the SV Y-Composite Graft (SV group, n = 112) or free RITA Y-Composite Graft (RITA group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or RITA). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; RITA group, 107). RESULTS: The overall Graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the RITA group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV Composite Grafts, was 97.1% (238 of 245) and was noninferior to that of the RITA Composite Grafts (97.1% [198 of 204]) with a 95% lower confidence limit of -2.6% (P < .001 for noninferiority). The Graft qualities, evaluated using the FitzGibbon patency grades, were also similar between the 2 groups (P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years (P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years (P = .597). CONCLUSIONS: The SV Composite Grafts were noninferior to the RITA Composite Grafts in terms of the 1-year angiographic patency rates.
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endothelial preservation of the minimally manipulated saphenous vein Composite Graft histologic and immunohistochemical study
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Ho Young Hwang, Mina Kim, Jeongwook Seo, Ki Bong KimAbstract:Objective We evaluated the efficacy of minimally manipulative surgical strategies to harvest the saphenous vein for use in a Y-Composite Graft based on the left internal thoracic artery in terms of preservation of endothelial structure and function. Methods Twenty patients who underwent off-pump coronary revascularization using the saphenous vein in a Y-Composite Graft based on the left internal thoracic artery were studied. The saphenous vein was harvested from each patient with minimal manipulation. An excess saphenous vein segment was removed before dilatation (control group), and a second segment was removed after dilation performed using a pressure-sensing syringe (conventional group). A third segment was obtained from a Y-Composite vein Graft dilated by flow and pressure from the left internal thoracic artery (Composite group). Hematoxylin–eosin staining and immunohistochemistry using antibodies against CD31, CD34, von Willebrand factor, and endothelial nitric oxide synthase were performed. A generalized estimating equation was adopted for statistical analysis. Results Histologic and immunohistochemical studies revealed better endothelial preservation in the Composite and control groups than in the conventional group ( P P Conclusions Harvesting of the saphenous vein using minimal manipulation for use in a Y-Composite Graft based on the left internal thoracic artery preserved endothelial structure and function when compared with manually dilated saphenous vein harvesting.
Arnold I Caplan - One of the best experts on this subject based on the ideXlab platform.
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tissue engineered fabrication of an osteochondral Composite Graft using rat bone marrow derived mesenchymal stem cells
Tissue Engineering, 2001Co-Authors: Jizong Gao, James E Dennis, Luis A Solchaga, Amad Awadallah, Victor M Goldberg, Arnold I CaplanAbstract:This study tested the tissue engineering hypothesis that construction of an osteochondral Composite Graft could be accomplished using multipotent progenitor cells and phenotype-specific biomaterial...
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tissue engineered fabrication of an osteochondral Composite Graft using rat bone marrow derived mesenchymal stem cells
Tissue Engineering, 2001Co-Authors: James E Dennis, Luis A Solchaga, Amad Awadallah, Victor M Goldberg, Arnold I CaplanAbstract:This study tested the tissue engineering hypothesis that construction of an osteochondral Composite Graft could be accomplished using multipotent progenitor cells and phenotype-specific biomaterials. Rat bone marrow-derived mesenchymal stem cells (MSCs) were culture-expanded and separately stimulated with transforming growth factor-β1 (TGF-β1) for chondrogenic differentiation or with an osteogenic supplement (OS). MSCs exposed to TGF-β1 were loaded into a sponge composed of a hyaluronan derivative (HYAF®-11) for the construction of the cartilage component of the Composite Graft, and MSCs exposed to OS were loaded into a porous calcium phosphate ceramic component for bone formation. Cell-loaded HYAFF®-11 sponge and ceramic were joined together with fibrin sealant, Tisseel®, to form a Composite osteochondral Graft, which was then implanted into a subcutaneous pocket in syngeneic rats. Specimens were harvested at 3 and 6 weeks after implantation, examined with histology for morphologic features, and stained ...
Robert W Hacker - One of the best experts on this subject based on the ideXlab platform.
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replacement of the aortic valve and ascending aorta with a valved stentless Composite Graft technical considerations and early clinical results
The Annals of Thoracic Surgery, 2000Co-Authors: Paul P Urbanski, Robert W HackerAbstract:Abstract Background . Replacement of the aortic valve and the ascending aorta with a conduit consisting of a mechanical valve and a Dacron tube has become a fairly common procedure. Commercially available conduits employing xenoGrafts are rarely used for the same purpose, because if a reoperation becomes necessary due to degeneration of the valve prosthesis, usually the entire conduit must be replaced. A Composite Graft with a stentless valve, such as we describe in this article, avoids this problem, because in case of reoperation only the valve cusps need to be resected and the tube Graft may be left in place. Methods . Surgical technique of replacement of the aortic valve and the ascending aorta with a stentless Composite Graft and early results of the procedure are presented. Results . Hemodynamics of the Graft soon after surgery were excellent, with an average systolic gradient of 8 mm Hg and no regurgitation across the valve. There were two reoperations for bleeding in the early postoperative period. Conclusions . The stentless Composite Graft we describe provides excellent hemodynamics, has no need for anticoagulation, and is expected to offer a benefit in case of reoperation.
Ki Bong Kim - One of the best experts on this subject based on the ideXlab platform.
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Saphenous vein as a Composite Graft from the internal thoracic artery
Annals of cardiothoracic surgery, 2018Co-Authors: Ho Young Hwang, Ki Bong KimAbstract:The saphenous vein (SV) has been used as an aortocoronary bypass Graft for coronary artery bypass Grafting (CABG) for the past 50 years. However, CABG using the aortocoronary SV has shown disadvantages of lower long-term Graft patency rates and subsequently worse clinical outcomes, compared with CABG using the internal thoracic artery (ITA). The advantages of CABG using the ITA prompted interest in total arterial revascularization, using the bilateral ITAs and other arterial conduits as Composite Graft configurations in patients exhibiting multi-vessel disease. Total arterial revascularization using a Y- or T-Composite Graft based on the in situ ITA increases the length of the arterial Graft and allows the extensive use of arterial conduits to revascularize both the left and right coronary territories. Further, it has demonstrated favorable outcomes in terms of angiographic patency rates, myocardial perfusion and thickening by single photon emission computed tomography, and long-term clinical outcomes. However, previous studies describing the use of the SV conduit as a Composite Graft have produced conflicting results. In this article, a recent surgical strategy of using the SV as part of a Composite Graft based on the in situ left ITA will be discussed.
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a randomized comparison of the saphenous vein versus right internal thoracic artery as a y Composite Graft save rita trial one year angiographic results and mid term clinical outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: Ki Bong Kim, Ho Young Hwang, Seokyung Hahn, Jun Sung KimAbstract:Objective The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial was designed to evaluate the noninferiority of the saphenous vein (SV) compared with the right internal thoracic artery ([R]ITA) used as a Y-Composite Graft. Methods A total of 224 patients who had undergone off-pump revascularization for multivessel coronary artery disease using the SV or RITA as a Y-Composite Graft based on the in situ left ITA were assigned randomly to the SV Y-Composite Graft (SV group, n = 112) or free RITA Y-Composite Graft (RITA group, n = 112). The primary endpoint was the 1-year angiographic patency rate of the second limb conduits (SV or RITA). Postoperative 1-year coronary angiograms were performed in 215 patients (SV group, 108; RITA group, 107). Results The overall Graft patency rate was 97.4% (745 of 765) at 1 year (97.9% in the SV group vs 96.9% in the RITA group, P = .362). The primary endpoint of the study, the 1-year patency rate of the SV Composite Grafts, was 97.1% (238 of 245) and was noninferior to that of the RITA Composite Grafts (97.1% [198 of 204]) with a 95% lower confidence limit of −2.6% ( P P = .948). No statistically significant differences were found in the overall survival rates between the 2 groups at 1 and 4 years ( P = .998). Also, no statistically significant differences were found between the 2 groups in the freedom from major adverse cardiac and cerebrovascular event rates at 1 and 4 years ( P = .597). Conclusions The SV Composite Grafts were noninferior to the RITA Composite Grafts in terms of the 1-year angiographic patency rates.
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endothelial preservation of the minimally manipulated saphenous vein Composite Graft histologic and immunohistochemical study
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Ho Young Hwang, Mina Kim, Jeongwook Seo, Ki Bong KimAbstract:Objective We evaluated the efficacy of minimally manipulative surgical strategies to harvest the saphenous vein for use in a Y-Composite Graft based on the left internal thoracic artery in terms of preservation of endothelial structure and function. Methods Twenty patients who underwent off-pump coronary revascularization using the saphenous vein in a Y-Composite Graft based on the left internal thoracic artery were studied. The saphenous vein was harvested from each patient with minimal manipulation. An excess saphenous vein segment was removed before dilatation (control group), and a second segment was removed after dilation performed using a pressure-sensing syringe (conventional group). A third segment was obtained from a Y-Composite vein Graft dilated by flow and pressure from the left internal thoracic artery (Composite group). Hematoxylin–eosin staining and immunohistochemistry using antibodies against CD31, CD34, von Willebrand factor, and endothelial nitric oxide synthase were performed. A generalized estimating equation was adopted for statistical analysis. Results Histologic and immunohistochemical studies revealed better endothelial preservation in the Composite and control groups than in the conventional group ( P P Conclusions Harvesting of the saphenous vein using minimal manipulation for use in a Y-Composite Graft based on the left internal thoracic artery preserved endothelial structure and function when compared with manually dilated saphenous vein harvesting.