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Published on: January 15, 2017
Long-term graft patency after coronary artery bypass grafting: Effects of morphological and pathophysiological
Grigore Tinica, Raluca Ozana Chistol1, Mihail Enache
1Department of Medical Imaging, "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi-Romania. ralucachistol@gmail.com.
Insights
Graft type, target vessel characteristics, and stenosis influence long-term success in coronary artery bypass grafting (CABG). Arterial grafts and saphenous vein grafts (SVGs) show varied patency rates based on these factors.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Biomedical Engineering
Background:
- Coronary artery bypass grafting (CABG) remains a cornerstone treatment for coronary artery disease.
- Long-term graft patency is crucial for the success of CABG procedures.
- Identifying factors influencing graft longevity is essential for improving patient outcomes.
Purpose of the Study:
- To investigate morphological and pathophysiological factors affecting the long-term patency of grafts used in CABG.
- To analyze the patency rates of different graft types (arterial vs. saphenous vein grafts) in specific coronary territories.
Main Methods:
- Analysis of 127 patients who underwent CABG between 2000-2006.
- Computed tomography evaluation of graft patency at an average of 140 months post-CABG.
- Assessment of 340 grafts, including left internal thoracic artery (LITA), right internal thoracic artery (RITA), radial artery (RA), and saphenous vein grafts (SVGs).
Main Results:
- Graft patency varied significantly by vessel type and coronary territory.
- Left internal thoracic artery (LITA) demonstrated the highest overall patency (90.16%).
- Radial artery (RA) showed the highest patency in the right coronary territory (80.65%), while saphenous vein grafts (SVGs) were most patent in the circumflex territory (82.54%).
- Target vessel characteristics, including degree of stenosis (<90%) and caliber (≤1.5 mm), significantly impacted arterial and SVG graft patency.
Conclusions:
- Graft type, target coronary territory, target vessel caliber, and degree of stenosis are critical determinants of long-term graft patency after CABG.
- These morphological parameters are essential for optimizing surgical strategy and improving graft longevity.
- Further research into optimizing graft selection and surgical technique based on these factors is warranted.
Objective:
The aim of the present study was to identify morphological and pathophysiological factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG).
Methods:
A total of 127 patients who underwent CABG between 2000 and 2006 and presented for computed tomography evaluation of graft patency at 139.78±36.64 months post-CABG were analyzed. Patients received 340 grafts (2.68 grafts/patient), 399 distal anastomoses (3.14 anastomoses/ patient), 220 (55.14%) performed using arterial grafts, and 179 (44.86%) using saphenous vein grafts (SVGs).
Results:
Graft patency varied according to vessel type and coronary territory. Overall graft patency was 90.16% for the left internal thoracic artery (LITA), 75.55% for the right internal thoracic artery (RITA), 79.25% for the radial artery (RA), and 74.3% for the SVG. The maximum patency rate was obtained with the RA (80.65%) for the right coronary territory, RITA (92.86%) for the anterolateral territory, and SVG (82.54%) for the circumflex territory. The LITA-left anterior descending artery graft occluded in 13 (7.93%) cases, 7 due to competitive flow. The influence of graft length on patency rates after indexing to height was not significant. The target vessel degree of stenosis influenced arterial graft patency rates with an occlusion odds ratio (OR) of 3.02 when anastomosed to target vessels with <90% stenosis. Target vessel caliber also influenced patency rates with occlusion ORs of 2.63 for SVGs and 2.31 for arterial grafts when anastomosed to ≤1.5 mm target vessels.
Conclusion:
Morphological parameters, such as graft type, target territory, target vessel caliber, and degree of stenosis, are important factors conditioning long-term graft patency.
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