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[Is extensive usage of arterial grafts in revascularization of the circumflex appropriate?: comparative study with
H Nishida1, S Nemoto, T Koyanagi
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
Insights
Arterial grafts show superior patency rates for coronary artery bypass grafting (CABG) of the circumflex artery (LCX) compared to saphenous vein grafts. This suggests arterial grafts are a valuable option for CABG, improving long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for treating coronary artery disease.
- Graft selection for revascularization of the circumflex artery (LCX) impacts long-term outcomes.
- Saphenous vein grafts and arterial grafts are primary options for CABG.
Purpose of the Study:
- To compare the efficacy of saphenous vein grafts versus arterial grafts for LCX revascularization in CABG.
- To evaluate graft patency rates, mortality, and event-free survival between graft types.
- To assess the impact of graft choice on the revascularization of the left anterior descending artery (LAD).
Main Methods:
- A retrospective study of 584 patients undergoing CABG from 1975 to 1992.
- Patients received either saphenous vein grafts (Group S) or arterial grafts (Group A) for LCX revascularization.
- Group S was further divided into subgroups based on the timing of arterial graft use for LCX.
Main Results:
- No significant differences in early or late mortality, or event-free curves were observed between groups.
- Arterial grafts (Group A) demonstrated a significantly higher patency rate (94.3%) compared to saphenous vein grafts (Group S I: 88.6%, Group S II: 87.7%).
- Graft flow was lower in arterial grafts, but patency remained superior. LAD revascularization patency was excellent in both groups.
Conclusions:
- Arterial grafts are associated with better long-term patency for LCX revascularization in CABG.
- The findings support the increased use of arterial grafts for the LCX when properly assigned.
- Optimizing graft selection can enhance CABG outcomes and maintain revascularization quality.
Abstract:
From September 1975 to March 1992, 584 patients underwent coronary artery bypass grafting (CABG) including revascularization of the circumflex artery (LCX) with either saphenous vein (Group S, n = 496) or arterial grafts (Group A, n = 88). Group S was divided into two subgroups. Group S I is the patients who underwent CABG before April 1988, when the first case of arterial revascularization of the LCX, and Group S II is the patients who underwent CABG after April 1988. No significant differences were noted in early mortality, late mortality, or event free curve among three groups. Although graft flow was significantly less in Group A (27.8 +/- 12.8 ml/min) than Group S (60.0 +/- 35.7 ml/min), the patency rate was better in Group A (94.3%) than Group S I (88.6%) or Group S II (87.7%). The proportion of usage of arterial grafts in revascularization of the left anterior descending artery (LAD) was smaller in Group A (65.5%) than Group S II (80.3%), but the patency rate was acceptably good in both groups (Group A: 98.8%, Group S II: 99.5%). These findings justify extensive usage of arterial grafts to the LCX area under proper assignment of grafts to obtain good patency rate and long-term results with keeping quality of revascularization of the LAD area.