Estadísticas

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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La superioridad de la arteria mamaria interna izquierda frente a la vena safena&#44; como injerto a la arteria coronaria descendente anterior&#44; ha sido demostrada de forma clara en muchos art&#237;culos que&#44; de forma retrospectiva y no aleatorizada&#44; muestran datos incontrovertibles&#46; La posibilidad de que el uso de la segunda arteria mamaria aumentara el beneficio del injerto de arteria mamaria izquierda se ha investigado durante muchos a&#241;os&#44; sin alcanzar conclusiones definitivas&#46; Sin embargo&#44; durante los &#250;ltimos a&#241;os&#44; diversos autores han precisado un resultado superior cuando se compara la revascularizaci&#243;n con arteria mamaria bilateral&#44; frente a la arteria mamaria &#250;nica&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Ha habido una preocupaci&#243;n justificada acerca del aumento de la morbilidad asociada con el uso de la arteria mamaria bilateral&#44; especialmente el riesgo de complicaciones de la herida esternal&#46; La introducci&#243;n de cambios t&#233;cnicos en la preparaci&#243;n de la arteria mamaria&#44; en particular la esqueletizaci&#243;n de la misma&#44; han mostrado una disminuci&#243;n de estos riesgos&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El uso de injertos bilaterales <span class="elsevierStyleItalic">in situ</span> tiene algunas limitaciones en cuanto a los vasos coronarios que deben ser injertados&#44; y en algunos pacientes&#44; la anatom&#237;a coronaria no se presta bien a la estrategia con arteria mamaria bilateral&#46; Sin embargo&#44; el reciente uso de injertos compuestos&#44; en los que la arteria mamaria derecha se anastomosa a la arteria mamaria izquierda como injerto en Y o T&#44; permite al cirujano mucha m&#225;s flexibilidad en el abordaje de los vasos coronarios de la pared lateral y posterior del ventr&#237;culo izquierdo&#46;</p>"
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The superiority of the left internal thoracic artery &#40;LITA&#41; over the saphenous vein graft &#40;SVG&#41; when the target vessel is the left anterior descending artery was clearly demonstrated in many papers that&#44; even if retrospective and non-randomised&#44; showed incontrovertible findings&#46; The possibility that the use of the second ITA could increase the benefit of the LITA was investigated for many years&#44; without reaching definitive conclusions&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">However&#44; during the last years&#44; many reports pointed out on the superior outcome when bilateral ITA was compared to the single ITA&#46; There has been a justified concern about the potential for increased morbidity associated with BITA most specifically the risk of sternal wound complications&#46; Changing techniques of ITA preparation&#44; in particular skeletonization&#44; seem to have decreased those risks&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The use of bilateral <span class="elsevierStyleItalic">in situ</span> grafts has some limitations regarding the coronary vessels that can be grafted&#44; and for some patients&#44; the coronary anatomy does not match well to the BITA strategy&#46; However&#44; the recent use of composite internal thoracic artery grafts&#44; where the RITA is anastomosed to the LITA as a Y or T graft allows the surgeon much more flexibility in grafting lateral wall and posterior vessels&#46;</p>"
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