Related Experiment Videos
[Sequential coronary artery bypass grafting using arterial conduits]
T Koyanagi1, M Endo, H Nishida
1Department of Cardiovascular Surgery, Tokyo Women's Medical College, Japan.
Insights
Sequential coronary artery bypass grafting (CABG) using arterial conduits shows high patency rates and reliability for multiple vessel grafting. Distal anastomoses occlusion was noted, suggesting careful conduit selection is crucial.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Arterial Conduits
Context:
- Coronary artery bypass grafting (CABG) is a common surgical procedure.
- Arterial conduits offer advantages over venous grafts.
- Sequential and skip bypass techniques are utilized to maximize graft utilization.
Purpose:
- To evaluate the efficacy and outcomes of sequential and skip coronary artery bypass grafting using in situ arterial conduits.
- To assess graft patency rates and reoperation requirements in patients undergoing these procedures.
Summary:
- Forty-one patients received sequential or skip CABG using left internal thoracic artery (LITA) or right gastroepiploic artery.
- No hospital deaths occurred; one late death from myocardial infarction in a skip bypass patient.
- Overall graft patency was 95% (77/81), with three reoperations, all LITA sequential grafts.
- Distal anastomoses occluded in 7 of 9 sequential grafts, while proximal anastomoses remained patent.
Impact:
- Sequential arterial grafting is a viable and reliable option for complex coronary artery bypass grafting.
- Graft caliber is critical; smaller conduits may be better suited for individual grafts rather than sequential configurations.
- Findings highlight the importance of distal anastomosis patency in sequential arterial grafting strategies.
Abstract:
Fourty one patients underwent sequential coronary artery bypass grafting (CABG) using in situ arterial conduits as sequential bypass grafts. Included were sequential bypass from diagonal branch to left anterior descending artery (LAD) using the left internal thoracic artery (LITA) in 29 patients, skip bypass from segment 7 to segment 8 (AHA classification) of LAD using LITA in 5 patients and sequential bypass to the distal branches of the right coronary and circumflex arteries using the right gastroepiploic artery in 7 patients. There were no hospital deaths and only one patient who received skip bypass died of heart attack a couple of years after-operation. The overall patency rate was 95% (77/81). Reoperations were done in three patients all of whom received sequential bypass using LITA. It was characteristic that the distal anastomoses of sequential graft occluded in 7 of 9 patients and those proximal anastomoses were patent. This procedure is one available and reliable option for multiple coronary bypass grafting. However, if the arterial conduits are too small in caliber to use for sequential grafts, they should be used as individual grafts.