SOL İNEN KORONER ARTER BYPASS GREFT POZİSYONUNDA SAFEN VEN VE SOL İNTERNAL MAMARİAL ARTERİN AÇIKLIKLARININ KARŞILAŞTIRILMASI [Comparison of Patency of the Saphenous Vein and Left Internal Mammary Artery in Left Descending Coronary Artery Bypass Graft Position] (original) (raw)
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2016
Objective: We aimed to evaluate long-term patency rates and clinical outcomes of the saphenous vein (SVG) and left internal mammary artery (LIMA) in left anterior descending coronary artery (LAD) position to investigate the optimum conduit for coronary artery bypass graft (CABG) operations. In addition we investigated the SVG patency in the other coronary artery positions. Methods: From January 2012 to November 2014, there were 178 patients who were previously undergone coronary artery bypass surgery and had ischemic symptoms, were restudied with coronary angiography in our hospital. We evaluated the preoperative and postoperative data of those patients. The patients were divided into two groups according to the graft anastamosed to LAD; LIMA group and SVG group. Grafts are defined as failed if there was occlusion, string sign, or greater than 80% stenosis. We analyzed also other coronary artery targets by subgroup analysis. Results: There were no significant differences between eac...
Annals of Thoracic Surgery, 1988
In 1975, 80 patients undergoing revascularization were prospectively randomized to receive either a greater saphenous vein (SV) graft (41 patients, Group 1) or a left internal mammary artery (LIMA) graft (39 patients, Group 2) to the left anterior descending coronary artery (LAD). All patients were completely revascularized. The average number of grafts per patient in both groups was 3.2. Patients were followed 10 years; follow-up was 97.5% complete. Group 1 and Group 2 were compared in regard to mortality, treadmill response, myocardial infarction, reoperation, percutaneous transluminal coronary angioplasty, and return to work. Mortality in Group 1 was 17.9% versus 7.7% in Group 2 ( p < 0.05). Treadmill studies were positive in 17 Group 1 patients and 7 Group 2 patients ( p < 0.05). Myocardial infarctions occurred in 8 patients in Group 1 versus 3 in Group 2. The number of reoperations was 2 in Group 1 versus 1 in Group 2. Percutaneous transluminal coronary angioplasty was performed in 3 patients in Group 1 and 2 in Group 2. Repeat studies revealed 76.3% patency of the SV graft to the LAD (Group 1) and 94.6% patency of the LIMA graft to the LAD (Group 2). Cardiac-related mortality in Group 1 was 12.8% at 10 years (5 patients) versus 7.7% in Group 2 (3 patients). Based on this study, the IMA is a superior conduit for bypass to the LAD.
Journal of the American College of Cardiology, 2004
OBJECTIVES This study defined long-term patency of saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts. BACKGROUND This VA Cooperative Studies Trial defined 10-year SVG patency in 1,074 patients and left IMA patency in 457 patients undergoing coronary artery bypass grafting (CABG). METHODS Patients underwent cardiac catheterizations at 1 week and 1, 3, 6, and 10 years after CABG. RESULTS Patency at 10 years was 61% for SVGs compared with 85% for IMA grafts (p Ͻ 0.001). If a SVG or IMA graft was patent at 1 week, that graft had a 68% and 88% chance, respectively, of being patent at 10 years. The SVG patency to the left anterior descending artery (LAD) (69%) was better (p Ͻ 0.001) than to the right coronary artery (56%), or circumflex (58%). Recipient vessel size was a significant predictor of graft patency, in vessels Ͼ2.0 mm in diameter SVG patency was 88% versus 55% in vessels Յ2.0 mm (p Ͻ 0.001). Other positive significant predictors of graft patency were use of aspirin after bypass, older age, lower serum cholesterol, and lowest Canadian Functional Class (p Ͻ 0.001 to 0.058). CONCLUSIONS The 10-year patency of IMA grafts is better than SVGs. The 10-year patency for SVGs is better and the 10-year patency for IMA grafts is worse than expected. The 10-year patency of SVGs to the LAD is better than that to the right or circumflex. The best long-term predictors of SVG graft patency are grafting into the LAD and grafting into a vessel that is Ͼ2.0 mm in diameter. (
Patencies of 2,127 arterial to coronary conduits over 15 years
The Annals of Thoracic Surgery, 2004
Background. Use of arterial grafts in coronary surgery is based on the excellent patency of the left internal thoracic artery (LITA) and an expectation that other arterial grafts-right internal thoracic artery (RITA) and radial artery (RA)-will give similar patencies, superior to saphenous vein. We examined patencies of arterial grafts in a practice with extensive use for more than 15 years.
Netherlands Heart Journal, 2016
Although the benefits of using the left internal mammary artery to bypass the left anterior descending artery (LAD) have been extensively ascertained, freedom from major cardiovascular events and survival after coronary artery bypass grafting (CABG) also correlate with the completeness of revascularisation. Hence, careful selection of the second-best graft conduit is crucial for CABG success. The more widespread use of saphenous vein grafts contrasts with the well-known long-term efficacy of multiple arterial grafting, which struggles to emerge as the procedure of choice due to concerns over increased technical difficulties and higher risk of postoperative complications. Conduit choice is at the discretion of the operator instead of being discussed by the heart team, where cardiologists are not usually engaged in such decisions due to a hypothetical lack of technical knowledge. Furthermore, according to the ESC/EACTS guidelines, traditional CABG remains the gold standard for multi-vessel coronary artery disease with complex LAD stenosis, but hybrid procedures using percutaneous coronary intervention for non-LAD targets could combine the best of two worlds. With the aim of raising the cardiologist's awareness of the surgical treatment options, we provide a comprehensive overview of the anatomical, functional and clinical aspects guiding the decision-making process in CABG strategy.
Annals of Thoracic and Cardiovascular Surgery, 2012
Aim: Late occlusion of bypass grafts is one of the main issues associated with long-term survival after coronary artery bypass grafting (CABG) surgery. Left coronary system is generally revascularized using arterial conduits, whereas saphenous venous grafts are used for right coronary system. We investigated the prognostic factors that are related to the patency and risk of occlusion of saphenous venous grafts used for revascularization of diseased right coronary arteries. Patients and Method: 92 patients who underwent CABG operation including a right coronary artery (RCA) bypass using saphenous venous graft (SVG) between January 2003 and July 2010 were evaluated retrospectively. Mean time of follow up was 66.9 ± 27.2 months (range 104-13 months). Grafts patencies were investigated using coronary angiography, and associated risk factors for mortality and morbidity were determined during the mid-term and long-term follow up. During the data collection phase, a significant association was noticed between patency of right coronary bypass grafts and site of distal anastomoses on RCA. Thus, patients were divided into two groups, according to the site of anastomosis. Right coronary anastomoses were performed either proximal (Group A, n = 44) or distal (Group B, n = 46) to the crux of the RCA (PDA). Results: Patency rates were similar in-group A (50% occluded and 50% patent) whereas patency rates were significantly higher in-group B (occluded 16.7%, patent 83.3%, p = 0.001). Mean age was significantly higher in-group A compared to Group B (p <0.05); however, there was no statistically significant difference between the two groups with regard to risk factors associated with cardiovascular disease (p >0.05). Also, mean diameter of the target vessel was significantly higher in-group A (p <0.01). Conclusion: Based on the results of our study we suggest that even though an appropriate segment for anastomosis is available proximal to the crux of the RCA, right posterior descending artery (PDA) should be preferred for revascularization when RCA is the target vessel in CABG.
Journal of the Saudi Heart Association, 2013
Coronary artery bypass grafting (CABG) was first used in the late 1960s. This revolutionary procedure created hope among ischemic heart disease patients. Multiple conduits are used and the golden standard is the left internal mammary artery to the left anterior descending artery. Although all approaches were advocated by doctors, the use of saphenous vein grafts became the leading approach used by the majority of cardiac surgeons in the 1970s. The radial artery graft was introduced at the same time but was not as prevalent due to complications. It was reintroduced into clinical practice in 1989. The procedure was not well received initially but it has since shown superiority in patency as well as long-term survival after CABG. This review provides a summary of characteristics, technical features and patency rates of the radial artery graft in comparison with venous conduits. Current studies and research into radial artery grafts and saphenous vein grafts for CABG are explored. However, more studies are required to verify the various findings of the positive effects of coronary artery bypass grafting with the help of radial arteries on mortality and long-lasting patency.
Journal of the American College of Cardiology, 2004
Background: The St. Jude Medical "Symmetry" aortic-saphenous vein graft connector system was introduced in the U.S. in 2001 as a suture-less method of performing proximal aortosaphenous vein anastomoses during coronary bypass surgery. Methods: Over a 27-month period (6/2001 to 9/2003) over 650 aortic-saphenous vein connectors were deployed in 400 coronary artery bypass graft (CABG) patients at our institution. The mean patient age was 66 years (range 37-86), and 65% of patients were male. The majority of patients were first-operation CABG, while 10% (41/400) were either redo CABG or combined valve-CABG procedures. Off-pump procedures were performed in 28% (99/359) of the first-time CABG procedures. Data for this study were gathered in a prospective fashion with regard to connector usage, while outcomes data were derived retrospectively from the cardiac surgery database. Results: Only 18 connectors required conversion to a hand-sewn anastomosis after deployment, primarily because of excessive bleeding at the anastomotic site. While re-exploration for bleeding was required in 2.7% (11/400) patients, bleeding was never attributed to the proximal connector site. Neurologic complications (stroke or delirium) occurred in 1.7% (7/400) of patients, and there were no post-operative myocardial infarctions. Post-operative (30-day) mortality was 2.2% (9/400) for this group of patients. To date we have documented only 3 graft failures attributed to the use of the proximal connector, with 2 occlusions and 1 ostial stenosis. Summary: Our substantial early experience with the "Symmetry" aortic-saphenous vein connector has demonstrated that a precise and hemostatic aortic-proximal saphenous vein connection is created using the system. There has been no documented morbidity related to the use of the connector in over 2 years of use. While long-term results with regard to graft patency have yet to be determined, our short-term operative results using the "Symmetry" connector appear to be no different than historic results for our program.