Refinement of Coronary Artery Bypass Grafting at Juntendo University Hospital

Figures

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  Figure 1. Postoperative cineangiography 1A Saphenous vein graft to left circumflex artery White allow is Saphenous vein graft. Blue allow is left circumflex artery Yellow allow is SVG disease due to neointima and atherosclerosis. 1B Left internal thoracic artery to left anterior descending artery White allow is left internal thoracic artery。Yellow allow is l left anterior descending artery

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  Figure 2. Changes of microscopic findings of IMA and SVG Internal mammary artery (IMA) saphenous vein graft (SVG). A,B. Histologic sections showing IMA and SVG obtained from a 76-year-old man who underwent coronary artery bypass graft (CABG) surgery 2 years. A: IMA shows no or rare intimal smooth muscle cells (SMCs) B: SVG exhibit moderate neointimal growth with few SMCs but rich in matrix which consists of proteoglycans and collagen. C,D: Histologic sections showing IMA and SVG obtained from a 69-year-old man who underwent CABG surgery 6 years ago. No intimal thickening in IMA C: The presence of moderate neointimal thickening in SVG from SMCs and proteoglycan-collagenous matrix at the site of anastomosis (arrow heads indicate suture sites) with left anterior descending artery (LAD) or left circumflex artery (LCX) E,F: IMA graft and SVG from a 77-year-old woman who underwent CABG surgery 12 years ago . While the IMA shows minimal intimal thickening, SVG exhibits moderate to severe neointimal growth with proteoglycan-collagen matrix and angiogenesis (arrows). Reprinted from Otsuka F, Yahagi K, Sakakura K. Why is the mammary artery so special and what protects it from atherosclerosis? Ann…

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  Figure 3. Changes in the Number of Surgeries for Ischemic Heart Disease at Juntendo University CABG: coronary artery bypass grafting AVR: aortic valve replacement LV plasty: left ventricular plasty

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  Figure 4. Primary isolated coronary artery bypass grafting at Juntendo University Changes of preoperative patients` baseline CVA: cerebrovascular accident, HD; hemodialysis, CKD: chronic kidney disease, DM: Diabetes Mellitus

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  Figure 5. Primary isolated coronary artery bypass grafting at Juntendo University Long-term results after coronary artery bypass grafting DM: patients with diabetes mellitus nonDM: patients without diabetes mellitus

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  Figure 6. Primary isolated coronary artery bypass grafting at Juntendo University Long-term results in the follow-up of patients with renal dysfunction

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  Figure 7. Late-onset AF free survival after CABG at Juntendo University In cases of transient postoperative atrial fibrillation, 20% will develop chronic atrial fibrillation 10 years later.

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  Figure 8. Neointima on the scar site after the left atrial appendage amputation Black arrow is thrombi in Left atrium. Red arrow is neointima. Reprinted from Endo D, Yamamoto T, Kuwaki K et al: Neointima on the scar site after the left atrial appendage amputation. J Card Surg, 2019; 34: 855.

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  Figure 9. Variations in the ligament of Marshall (LOM) anatomy Variations of LOM(ligament of Marshall) anatomy. A black circle in A1 indicates the proximal connection of the LOM to the CS. A2: A different view of the same heart. The distal end of the LOM inserts into the LSPV. A3: A second heart in which LOM was completely attached to the epicardium. A discrete ligament was not identified. B1: Proximal connection (arrow) between the LOM and the CS. B2: Both the proximal and distal connections of the LOM (2 arrows) in a second heart. B3: A third heart, which seems to have multiple muscle fibers (arrows) connecting the LOM and the LA. Reprinted from Hwang C, Chen PS. Ligament of Marshall: why it is important for atrial fibrillation ablation. Heart Rhythm. 2009; 6(12 Suppl): S35-40.

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  Figure 10. The impact of surgical left atrial appendage amputation/ligation on stroke prevention in patients undergoing off-pump coronary artery bypass grafting. A: Stroke-free survival curve LAA: left atrial appendage POSR: postoperative sinus rhythm POAF: postoperative atrial fibrillation

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  Figure 11. 1 Resection of Marshall ligament in ganglionated plexus(GP) A PA: pulmonary artery LUPV: left upper pulmonary vein Blue arrow is Marshall ligament. B The microscopic photo of resected Marshall ligament. Black arrow is the ganglion and sympathetic nerve fibers.

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  Figure 12. Prevalence of atrial fibrillation by age at the time of the survey in Japanese dialysis patients (Dec. 31, 2019) Reprinted from An Overview of Regular Dialysis Treatment in Japan. 2019 Report, The Japanese Society for Dialysis Therapy 2020: https://docs.jsdt.or.jp/overview/index.html