The efficacy and safety of additional bypass graft during isolated coronary artery bypass grafting
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Published on: September 15, 2023
Kazuhito Imanaka1, Shunei Kyo, Masayuki Ishikawa
1Department of Cardiovascular Surgery, Saitama Medical school, Moroyama-machi, Iruma-gun, Japan.
Insights
Adding extra coronary artery bypass grafts effectively treated 94.5% of patients experiencing hemodynamic issues during surgery. This strategy proved safe and improved survival rates, though careful consideration is advised.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for coronary artery disease.
- Undesirable hemodynamic conditions or regional asynergy can occur during CABG surgery.
- Suboptimal graft flow or coronary artery spasm may lead to these complications.
Purpose of the Study:
- To evaluate the effectiveness and safety of placing additional saphenous vein grafts in patients experiencing suboptimal conditions during isolated CABG.
- To determine the impact of additional bypass grafts on hemodynamic stability, graft flow, and patient outcomes.
Main Methods:
- Retrospective analysis of 19 patients undergoing isolated CABG with additional saphenous vein grafts.
- Grafts were placed onto the left anterior descending (LAD), right, and left circumflex (LCx) coronary arteries.
- Assessment of graft flow, myocardial ischemic time, and patient outcomes including survival and need for reintervention.
Main Results:
- Additional bypass grafts were effective in 94.5% of patients.
- 17 out of 19 patients (89.5%) survived and were discharged from the hospital.
- Median follow-up was 63 months, with 2 patients experiencing graft occlusion and positive ischemia tests.
Conclusions:
- Placement of additional bypass grafts is an effective and relatively safe strategy for managing undesirable hemodynamic conditions during isolated CABG.
- Careful patient selection and decision-making are crucial when considering additional bypass grafts.
- The procedure demonstrated positive short-term and long-term outcomes, with a low rate of reintervention.
Abstract:
In 19 patients with an undesirable hemodynamic condition (n=15) or with regional asynergy and coexistent ST-T change (n=4) during isolated coronary artery bypass grafting (CABG) surgery, one (n=17) or two (n=3) additional saphenous vein grafts were placed onto left anterior descending (LAD) (n=16), right (n=4), and left circumflex (LCx) (n=2) coronary arteries. Diagnosis of the cause of the suboptimal condition was insufficient graft flow in 16 patients, and spasm of the ungrafted coronary artery in 3. Additional myocardial ischemic time was 17 9 minutes, and the graft flow was 59 25 ml/min. Additional bypass was effective in 94.5%. Eighteen patients could be weaned from cardiopulmonary bypass, and 17 (89.5%) survived and were discharged from hospital. Median duration of mechanical ventilatory support and intensive care unit stay was 15 hours and 4 days, respectively. During 63 44 months follow-up, the additional graft was occluded and the treadmill test was positive for ischemia in 2 patients, and one child patient is now considered for redo CABG. Placement of additional bypass grafts thus appeared to be an effective and relatively safe strategy, although the decision has to be made cautiously.
