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Published on: November 19, 2019
[Failure of internal thoracic-coronary artery bypass graft. What are the reasons?]
E Bezon1, A Karaterki, J A Barra
1Service de chirurgie cardiaque, thoracique et vasculaire, CHU La Cavale-Blanche, Brest.
Insights
Internal thoracic artery grafts can fail due to graft issues or patient factors. Many failures in coronary bypass grafting are avoidable with better preoperative assessment and surgical technique.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Medical Imaging
Context:
- Coronary artery bypass grafting (CABG) is a critical intervention for ischemic heart disease.
- The internal thoracic artery (ITA) is a preferred conduit for CABG due to its long-term patency.
- Graft failure can lead to adverse clinical outcomes and necessitate reintervention.
Purpose:
- To investigate the causes of failure in internal thoracic artery (ITA) grafts used in coronary bypass grafting.
- To analyze factors contributing to graft occlusion and non-functionality.
- To identify potential areas for improvement in patient selection and surgical execution.
Summary:
- This study reviewed 512 ITA grafts in 302 patients, identifying 30 failures (2% occluded, 4% non-functional).
- Non-functional grafts were often attributed to competitive flow (e.g., overestimated coronary stenoses, secondary regressions) or poor distal run-off.
- At least two-thirds of ITA graft failures were deemed avoidable through improved preoperative coronary angiography interpretation and surgical technique.
Impact:
- Findings highlight the importance of accurate preoperative assessment of coronary stenosis severity.
- Results suggest that optimizing surgical technique can reduce the incidence of internal thoracic artery graft failure.
- This research contributes to improving long-term outcomes for patients undergoing coronary artery bypass grafting.
Abstract:
The aim of this study was to identify the causes of failure of coronary bypass grafting with the internal thoracic artery. A total of 512 internal thoracic artery grafts in 302 patients were reviewed. Control coronary angiography was performed after an average of 17.3 months (sigma = 4.1 months). Were considered as failures: 11 (2%) occluded grafts and 19 (4%) non-functional (narrowed internal thoracic artery) grafts. The appearances of the anastomosis, presence or absence of stenosis, origin of flow at the anastomosis and distal run-off of the grafted coronary artery, were analysed. Of the 19 non-functional grafts, there were no stenosis of the anastomosis of the narrowed internal thoracic arteries; in 14 cases, competitive flow was observed (2 internal thoracic artery steal syndromes by non-obstructed proximal collateral branches, 8 initially overestimated coronary stenoses, 4 secondary regressions of coronary stenosis); there was poor distal run-off of the grafted artery in 4 cases and significant coronary stenosis distal to the graft in one case. This study shows that, of the 30 failures of internal thoracic artery grafting, at least 2/3 were "avoidable" by a more accurate evaluation of the coronary stenosis on the preoperative coronary angiography and by better surgical technique.
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