Related Experiment Videos
[Free arterial graft for coronary bypass grafting]
A Yamaguchi1, N Kitamura, H Irie
1Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
Insights
Free arterial grafts, including the left internal thoracic artery (LITA) and right internal thoracic artery (RITA), demonstrate excellent patency and angina relief in coronary artery bypass grafting. This technique offers a viable alternative for complete arterial revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Coronary Artery Bypass Grafting
Background:
- Arterial grafts are increasingly utilized in coronary artery bypass grafting (CABG) for improved long-term patency.
- Free arterial grafts offer versatility in complex revascularization scenarios.
Purpose of the Study:
- To evaluate the efficacy and safety of free arterial grafts in CABG.
- To assess graft patency and clinical outcomes using a specific proximal anastomosis technique.
Main Methods:
- A retrospective analysis of 39 patients undergoing CABG with 41 free arterial grafts between 1991 and 1993.
- Graft materials included left and right internal thoracic artery (LITA, RITA) and right gastroepiploic artery (GEA).
- A specific proximal anastomosis technique involving single aortic cross-clamping was employed.
Main Results:
- All 41 free arterial grafts were patent within one month post-operation.
- Complete arterial revascularization was achieved in 72% of patients.
- Mean follow-up of 27 months showed patients were free from angina; low perioperative complication rates (2.6% MI, 5.1% wound complications).
Conclusions:
- The proximal anastomosis technique for free arterial grafts is an acceptable and effective alternative for surgeons.
- Excellent graft patency and significant angina relief support the wider adoption of free arterial grafts in CABG.
Abstract:
Free arterial grafts were aggressively placed in 39 patients (1991 to 1993). There were 34 males and 5 females, and mean age was 59.9 year old. Of 85 arterial grafts, 41 were free grafts, and their materials included left and right internal thoracic artery (LITA, RITA) and right gastroepiploic artery (GEA). There were one free LITA-left anterior descending coronary artery (LAD), seven free RITA-LAD, three free RITA-diagonal branch (Dx), 14 free RITA-left circumflex coronary artery (LCX), 10 free RITA-right coronary artery (RCA), two sequential RITA-Dx-LCX, one free GEA-Dx, two free GEA-LCX, and one free GEA-RCA bypass. Of 41 free arterial grafts, 38 were in the aorta-coronary position, and the proximal anastomosis was constructed first under single aortic cross-clamping to get the larger anastomotic sites for both at the proximal and distal ends of the arterial graft. The proximal sites of the remaining 3 arterial grafts were placed to concomitantly utilized saphenous vein grafts in two patients and RCA in one patient because of their shortness. Perioperative complications included no exploration for bleeding, myocardial infarction in one (2.6%), intra-aortic balloon pumping in three (7.7%), and wound complications in two (5.1%). 28 cases (72%) were completely revascularized with only arterial grafts. Of 41 free arterial grafts studied within one month after operation, all grafts were patent. All patients were free from angina after a 27 months mean follow-up. We believe that the proximal anastomosis technique for free arterial graft we used could be acceptable alternative for many surgeons. These excellent results justify wider use of free arterial grafts.