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Published on: August 2, 2024
Preoperative graft assessment in aortocoronary bypass surgery
Grigore Tinica1, Cristina Luca Vartic1, Veronica Mocanu2
1Department of Cardiovascular Surgery, 'Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases, Iasi 700503, Romania; Department of Morpho-Functional Sciences, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi 700115, Romania.
Insights
Coronary artery bypass graft (CABG) surgery involves examining internal thoracic artery (ITA), radial artery (RA), and saphenous vein (SV) grafts. Histological analysis revealed varying intimal thickness indices, with ITAs showing the highest, impacting graft viability.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Histopathology
Background:
- Coronary artery bypass graft (CABG) surgery is crucial for improving myocardial blood supply.
- Graft selection (internal thoracic artery, radial artery, saphenous vein) impacts long-term outcomes.
- Understanding graft morphology and risk factors is key to optimizing CABG efficacy.
Purpose of the Study:
- To investigate the morphology of distal segments of ITA, RA, and SV grafts used in CABG.
- To assess graft patency and viability through histological and morphometric analyses.
- To identify clinical and laboratory risk factors associated with lesion severity in CABG grafts.
Main Methods:
- Histological analysis of 54 distal graft segments (ITA, RA, SV) from 58 patients (42-78 years).
- Morphometric assessment of intimal thickness index (ITI) and luminal narrowing.
- Evaluation of patient risk factors for atherosclerosis (hypertension, hyperlipidemia, diabetes, smoking, obesity).
Main Results:
- Histological changes included atheromatous plaques and intimal/medial thickening.
- Mean ITI was significantly higher in ITA (1.66) compared to RA (0.95) and SV (0.37).
- All patients exhibited atherosclerosis risk factors; venous grafts showed potential viability reduction due to pre-existing lesions.
Conclusions:
- Graft morphology, particularly intimal thickness, varies significantly among ITA, RA, and SV conduits.
- Pre-existing atherosclerotic lesions in grafts, especially venous ones, may compromise long-term patency and viability.
- Long-term follow-up is essential to determine the clinical impact of these graft lesions.
Abstract:
Coronary artery bypass graft (CABG) is a surgical procedure able to improve the blood supply to the myocardium. In the present study, the distal segments of grafts taken from the internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) for use in aortocoronary bypass surgery were examined. The morphologies of the grafts were investigated in order to draw conclusions concerning their patency and viability. In addition, clinical and laboratory risk factors considered to be significant predictors of lesion severity in graft vessels used in CABGs were investigated. In total, 54 distal graft segments of ITAs, RAs and SVs from 20 men and 6 women aged between 42 and 78 years, were evaluated. Histological analyses were used to visualize graft lesions. Morphometrically, the intimal thickness index (ITI) and luminal narrowing were assessed as an indication of graft patency. The histological changes observed in the graft vessel walls included the presence of distinct atheromatous plaques (fatty streaks in 2 cases) or thickening of the intima (20 cases) and media (17 cases). Morphometric analysis showed that the mean ITI of the vessel conduits was 0.37 in the SVs, 0.95 in the RAs, and 1.66 in the ITAs. No patient had >50% conduit stenosis. By assessing the association between risk factors and graft lesions, it was found that all the patients showed risk factors for atherosclerosis, such as age (61.54%), arterial hypertension (65.38%), hyperlipidemia (65.38%), smoking (34.61%), diabetes mellitus (38.46%) and obesity (15.38%). The presence of pre-existing lesions in bypass grafts may contribute to a reduction in their viability, particularly in the case of venous grafts. Further long-term follow-ups are mandatory to evaluate the consequences of such lesions upon the patency of the grafts.
