Effect of Proximal Anastomotic Diameter on Venous Bypass Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (original) (raw)
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Assessment of an aortosaphenous vein graft anastomotic device in coronary surgery
The Annals of Thoracic Surgery, 2002
Background. Until now technologic evolution in coronary bypass surgery has focused on extracorporeal circulation, on operation without extracorporeal circulation, and on the exposure of the operative site. Recently a one-shot anastomotic device for the proximal anastomosis in coronary surgery was developed. We investigated whether the use of the aortic connector system (ACS) could facilitate the creation of aortosaphenous vein graft anastomoses in myocardial revascularization.
Cardiovascular journal of Africa, 2016
This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention. The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42-80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubul...
Critical Analysis of the Preoperative and Operative Predictors of Aortocoronary Bypass Patency
Annals of Surgery, 1981
A prospective analysis of the angiographic and operative anatomic and reconstructive variables that influenced graft patency was undertaken at the University of Virginia Medical Center in 50 consecutive patients. Postoperative restudy showed that 18 of the 168 grafts performed were occluded due to venous disease, inadequate run-off, or sequential design error. Angiographic artery size was 27% larger than operative estimations; graft patency significantly increased with increasing distal artery diameter, with decreasing venous conduit diameter, and with good graftability rating pf the vessels pre6peratively. Ejection fraction, the degree of arterial stenosis, and the source of the saphenous vein conduit (the thigh or the lower leg) had no influence on graft patency. Simple grafts had a 96% patency, while sequential grafts had an 80% patency. When design error for sequential grafts was eliminated, the sequential patency rate rose to 88%. For revascularization of small circumflex vessels, consideration should be given to variation in the sequential grafting technique to improve patency in these vessels. E VALUATION OF AN INDIVIDUAL in terms of being a "good candidate" or a "poor candidate" for coronary revascularization is usually based on a composite analysis of symptoms, age, bodily habitus, personality, and motivation, as well as coronary arteriographic and ventriculographic findings. Interpretation of such objective signs as stenotic lesions seen on coronary angiography varies from one observer to another, and even the same individual will grade the same stenosis differently on different occasions.3 6 Such interobserver and intraobserver variability is a significant problem.56 Similarly, the assessment of the distal vessel in terms of suitability for bypass grafting (graftability) also varies. A distal vessel with a large internal diameter (2 mm or larger) free of local or distal disease is optimal for grafting and one presumes these vessels have a better chance of long-term patency ;2 13 whereas the smaller vessel (1.0-1.5 mm internal diameter) with local or diffuse distal disease is felt to have a lower chance of long-term patency, and is regarded as less suitable for grafting.17
Circulation, 1979
Early and late (range 5-73 months, average 2.5 years) postoperative arteriographic studies were performed in 85 patients after saphenous vein aortocoronary bypass surgery. In a prior study (< 2 weeks postoperative) of 570 patients with 1197 grafts, arteriography revealed 89.6% early patency of grafts. Late follow-up in 85 patients discharged with all grafts patent revealed 92.2% still patent, an annual mean graft attrition rate (percent of grafts closed/year) of 3.2%/year. This mean graft attrition rate was only slightly affected by regrouping patients according to the interval between the two postoperative studies; however, recurrent angina pectoris was influenced by vein graft attrition. Thus, in 36 patients restudied because of recurrent angina pectoris, the attrition rate was 6.1%/year, compared with 1.1%/year in 49 patients without angina. Progressive coronary artery disease (41% vs 18%), graft closure (22% vs 4%) and incomplete revascularization (39% vs 16%) were significantly more frequent in those with recurrent angina. The frequency of progressive coronary disease was directly related to the duration of follow-up (i.e., the longer the follow-up the higher the frequency of progressive disease). The mean annual rate of progressive coronary disease in arteries not grafted was 11.8%/year. Kinking or graft stenosis was observed in 3.1% of grafts in the early study, while late localized graft narrowing was observed in 8%. At late follow-up, most patent grafts were uniformly narrowed and foreshortened. The mean graft diameter decreased by 17% at late follow-up, and 25% of grafts had at least 25% reduction in mean diameter; however, the mean graft diameter/mean recipient artery diameter ratio exceeded 1.0 in all but one graft. The graft/artery diameter ratio at late follow-up was over 1.5 in 71% of the grafts. The mean graft blood flow determined by cinedensitometric methods revealed a 30% or more reduction in blood flow in 35% of grafts, compared with early postoperative measurements.
Revista brasileira de cirurgia cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
To determine whether the proximal anastomosis interferes or not in mid- and long-term patency of these grafts. One hundred twenty-three out of 481 patients who had undergone surgery using radial artery (RA) were restudied. The mean age was 58.8 + 10.4 years. In 96 (78.05%) patients the cardiopulmonary bypass (CPB) was used. Considering all surgical grafts, 382 coronary branches were grafted (mean, 3.1 + 0.8 arteries per patient). 150 of them used radial artery (RA), and the left marginal branches (LOM) were the most prevalent (48.67%). The proximal anastomosis was performed in the aorta in 50 (40.65%) patients and as an artificial 'Y' composite graft with the left or right internal thoracic artery (LIMA/RITA) in 73 (59.35%). Postoperatively, coronary angiography studies were performed within a mean period of 5.36 + 3.21 years. The obtained data was divided into two categories: proximal anastomosis (aorta/composite) and patency (occluded/patent). A chi-square test was used to...
The Journal of Thoracic and Cardiovascular Surgery, 2009
Objective: During coronary surgery, proximal vein graft anastomoses have been performed by using an aortic partial occlusion clamp to allow for a hand-sewn anastomosis. The purpose of this multicenter, prospective, randomized trial was to evaluate the efficacy of the PAS-Port device (Cardica, Inc, Redwood City, Calif), which allows an automated proximal anastomosis to be performed without aortic clamping. Between June 22, 2006, and March 22, 2007, 220 patients requiring coronary artery bypass grafting with at least 2 vein grafts were enrolled. Within each patient, 1 graft was randomly assigned to receive a PAS-Port device, and the other was assigned to receive a hand-sewn anastomosis to the ascending aorta. The primary end point was angiographic patency (<50% stenosis) 9 months after surgical intervention. Secondary end points included average time to complete each anastomosis and 9-month freedom from major adverse cardiac events.