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[Coronary bypass surgery using arterial conduit and its pitfall]
T Fujiwara1, H Yamane, H Yoshida
1Department of Thoracic Surgery, Kawasaki Medical School.
Insights
Severe arterial graft spasm after coronary bypass surgery can cause critical complications. Promptly adding a saphenous vein graft may improve outcomes in such cases.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure.
- Arterial grafts are increasingly used for improved long-term patency.
- Graft spasm can compromise immediate surgical success.
Observation:
- Three patients experienced immediate severe spasm of internal mammary and gastroepiploic arteries post-CABG.
- Doppler velocimetry showed absent diastolic flow in spastic grafts.
- Patients required additional saphenous vein grafts to wean from cardiopulmonary bypass.
Findings:
- Intractable arterial graft spasm led to hemodynamic instability.
- Despite interventions, two of three patients died postoperatively.
- Sufficient initial flow and technically adequate anastomoses were confirmed.
Implications:
- Profound arterial conduit spasm necessitates urgent management.
- Consider intraoperative saphenous vein grafting for intractable spasm.
- Early graft failure and mortality are risks associated with severe spasm.
Abstract:
Three patients with spasm of internal mammary arteries and gastroepiploic artery immediately after coronary bypass surgery were reported. On completion of the revascularization, all patients could not be weaned from cardiopulmonary bypass. The flow velocity waveforms of the arterial grafts measured by pulsed Doppler velocimeter showed only small systolic component without diastolic flow and the palpation revealed profound spasm partially in the arterial conduits. Although all patients could be weaned from cardiopulmonary bypass only after insertion of a saphenous vein graft, two of them died on the next day. In all patients, free flow measured prior bypass was considered to be sufficient and a technically satisfactory anastomosis was felt to be performed. If a profound hemodynamic instability as a result of intractable spasm of arterial conduit occurred after completion of coronary bypass surgery, an additional saphenous vein graft should be placed before discontinuation of cardiopulmonary bypass.