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Arterial graft patency in coronary artery bypass grafting: what do we really know?
M J Mack1, J A Osborne, H Shennib
1Medical City Dallas Hospital, Texas, USA. mmack@crsti.org
Insights
Graft patency for left internal mammary artery (LIMA) bypass to the left anterior descending artery is high with both beating heart and conventional techniques. Early graft patency exceeds 90% for both methods, ensuring effective coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Outcomes
Background:
- Increasing use of beating heart techniques for coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) to bypass the left anterior descending artery.
- Concerns regarding the graft patency of beating heart techniques compared to conventional arrested heart techniques.
Purpose of the Study:
- To review and analyze published literature on the outcome efficacy of LIMA grafts to the left anterior descending coronary artery.
- To compare graft patency rates between beating heart and conventional CABG techniques.
Main Methods:
- Systematic review of all published articles examining LIMA graft outcomes to the left anterior descending artery.
- Inclusion of only studies with angiographic follow-up, considered the gold standard for assessing graft patency.
Main Results:
- Analysis of 37 publications from 1972-1998, with 27 providing angiographic follow-up data.
- Early graft patency (< or =1 month) ranged from 94% to 99% in conventional CABG.
- Late graft patency (up to 15 years) ranged from 51% to 98%.
- Minimally invasive direct coronary artery bypass grafting (MIDCAB) showed early LIMA graft patency rates between 91% and 99%.
Conclusions:
- Direct comparison of LIMA graft patency between arrested heart and beating heart techniques is challenging.
- Early graft patency for LIMA to the left anterior descending artery is confidently established as 90% or greater for both conventional and minimally invasive approaches.
Background:
With increasing use of beating heart techniques for bypass of the left anterior descending coronary artery with the left internal mammary artery (LIMA), appropriate concerns have been raised of whether graft patency by these techniques compares favorably with conventional, arrested heart techniques.
Methods:
All published articles that examine outcome efficacy of the LIMA graft to the left anterior descending coronary artery were reviewed. Because angiography has been considered the "gold standard," only those studies that included angiographic follow-up were analyzed.
Results:
From 1972 through 1998, there have been 37 peer-reviewed publications that examined outcomes of LIMA grafting in conventional coronary bypass grafting, of which 27 contained angiographic follow-up data. The completeness of angiographic follow-up was variable, but early graft patency (< or =1 month) in studied patients ranged between 94% and 99%. Late graft patency (up to 15 years) ranged from 51% to 98%. Five recent series of minimally invasive direct coronary artery bypass grafting that contained LIMA graft patency data show early graft patency rates between 91% and 99%.
Conclusions:
Meaningful comparison of LIMA graft patency between arrested heart, conventional coronary artery bypass grafting, and minimally invasive direct coronary artery bypass grafting is difficult; however, early graft patency by both techniques can confidently be stated as being 90% or greater.