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Published on: May 14, 2013
Use of arterial grafts for coronary revascularization. Experience of 2987 anastomoses
Y Tomizawa1, M Endo, H Nishida
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan.
Insights
The internal thoracic artery demonstrates superior patency and quality for coronary artery bypass grafting (CABG). Gastroepiploic and radial arteries are viable alternatives, but require careful consideration of patient-specific factors.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Outcomes Research
Background:
- Coronary artery bypass grafting (CABG) relies on suitable arterial and venous grafts.
- Optimizing graft selection is crucial for long-term CABG success.
- Arterial grafts are increasingly favored over saphenous vein grafts due to improved patency rates.
Purpose of the Study:
- To evaluate the performance and quality of various arterial grafts used in CABG.
- To compare the patency rates and histological characteristics of different arterial conduits.
- To establish evidence-based recommendations for arterial graft selection in CABG.
Main Methods:
- A retrospective analysis of 2987 arterial grafts (internal thoracic, gastroepiploic, radial arteries) and 1225 saphenous vein grafts from 1673 patients between 1970 and 1998.
- Early graft patency assessed via angiography.
- Histological evaluation of operative specimens and preoperative angiographic assessment of arterial grafts.
Main Results:
- Overall graft patency rate was 94.8% among 3714 evaluated grafts.
- Internal thoracic artery exhibited significantly higher patency rates compared to gastroepiploic artery, radial artery, and saphenous vein grafts (p < 0.0001).
- Gastroepiploic artery showed better patency than saphenous vein grafts (p = 0.04), with no significant difference versus radial artery. Histological analysis revealed atherosclerotic changes in gastroepiploic artery specimens, unlike internal thoracic artery.
Conclusions:
- Internal thoracic artery is the preferred graft for CABG, followed by the right internal thoracic artery.
- Gastroepiploic artery and radial artery are suitable third choices, with selection dependent on anastomotic site and lesion characteristics.
- Histological and angiographic findings support the superiority of internal thoracic artery and highlight potential limitations of other arterial grafts.
Objectives:
The aim of this study was to evaluate the performance and the quality of arterial grafts for coronary artery bypass grafting at The Heart Institute of Japan, Tokyo Women's Medical University.
Patients And Methods:
From January 1970 to March 1998, 2987 arterial grafts, including left and right internal thoracic arteries, gastroepiploic artery, radial artery and inferior epigastric artery, were used in 1673 patients. In the same period, 1225 saphenous vein grafts were used. Early graft patency was angiographically determined. Also, histological evaluation of operative specimens and preoperative angiographic evaluation of arterial grafts were performed.
Results:
The total number of hospital deaths was 38 (2.3%). Of 4212 grafts, 3919 grafts (93%) were evaluated angiographically and 3714 of 3919 grafts were patent (94.8%). The patency rate of internal thoracic artery was better than that of gastroepiploic artery (p < 0.0001), radial artery (p = 0.0005) and saphenous vein grafts (p < 0.0001). However, the patency rate of gastroepiploic artery was better than that of saphenous vein grafts (p = 0.04), while no significant difference was detected between gastroepiploic artery and rdial artery. Only one internal thoracic artery specimen obtained at surgery showed atherosclerotic change, but all gastroepiploic artery specimens had moderate to severe atherosclerotic changes with CD68-positive cell infiltration. Only one patient's left internal thoracic artery out of 200 was not angiographically useable as a conduit, while multiple stenotic lesions in gastroepiploic artery were observed.
Conclusions:
In the graft selection for CABG, the primary choice is internal thoracic artery and the secondary choice is right internal thoracic artery, from the standpoint of histological and angiographic evaluation, gastroepiploic artery and/or radial artery, depending on the target anastomotic site, degree of stenosis, and in situ or free use is the third choice.
