Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Tinica,Grigore; Chistol,Raluca  Ozana; Bulgaru Iliescu,Diana; Furnica,Cristina

doi:10.3892/etm.2018.6929

Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

Authors:
- Grigore Tinica
- Raluca Ozana Chistol
- Diana Bulgaru Iliescu
- Cristina Furnica
View Affiliations

Affiliations: Department of Cardiovascular Surgery, ‘Prof. Dr. George I.M. Georgescu’ Cardiovascular Diseases Institute, 700503 Iasi, Romania, Department of Medical Imaging, ‘Prof. Dr. George I.M. Georgescu’ Cardiovascular Diseases Institute, 700503 Iasi, Romania, Discipline of Forensic Medicine, Medical Department III, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania, Institute of Forensic Medicine, 700455 Iasi, Romania
Published online on: November 6, 2018 https://doi.org/10.3892/etm.2018.6929
Pages: 359-367
Copyright: © Tinica et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The aim of the current study was to identify surgical factors associated with long‑term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post‑CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21˚ for patent arterial grafts vs. 56˚ for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60˚ for patent side‑to‑side anastomosis vs. 53.97˚ for occluded, 65.12˚ for patent end‑to‑side anastomosis vs. 90.80˚ for occluded; in single end‑to‑side anastomosis of arterial grafts, 39.46˚ for patent and 44.94˚ for occluded). A single end‑to‑side anastomosis angle 60˚ or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end‑to‑side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long‑term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.

View Figures

View References

1	Eurostat-Cardiovascular diseases statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Cardiovascular_diseases_statisticsAugust 31–2017
2	Eurostat-Surgical operations and procedures statistics. http://ec.europa.eu/eurostat/statistics-explained/index.php/Surgical_operations_and_procedures_statisticsAugust 31–2017
3	Authors/Task Force members, . Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, et al: 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 35:2541–2619. 2014. View Article : Google Scholar : PubMed/NCBI
4	Coronary Revascularization Writing Group, . Patel FR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA; Technical Panel, ; Masoudi FA, Dehmer GJ, Patel MR, et al: ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Thorac Cardiovasc Surg. 143:780–803. 2012. View Article : Google Scholar : PubMed/NCBI
5	Sabik JF III: Understanding saphenous vein graft patency. Circulation. 124:273–275. 2011. View Article : Google Scholar : PubMed/NCBI
6	Tatoulis J, Buxton BF and Fuller JA: Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg. 77:93–101. 2004. View Article : Google Scholar : PubMed/NCBI
7	Cameron AA, Green GE, Brogno DA and Thornton J: Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol. 25:188–192. 1995. View Article : Google Scholar : PubMed/NCBI
8	Taggart DP, D'Amico R and Altman DG: Effect of arterial revascularisation on survival: A systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 358:870–875. 2001. View Article : Google Scholar : PubMed/NCBI
9	Georghiou GP, Vidne BA and Dunning J: Does the radial artery provide better long-term patency than the saphenous vein? Interact Cardiovasc Thorac Surg. 4:304–310. 2005. View Article : Google Scholar : PubMed/NCBI
10	Petrovic I, Nezic D, Peric M, Milojevic P, Djokic O, Kosevic D, Tasic N, Djukanovic B and Otasevic P: Radial artery vs saphenous vein graft used as the second conduit for surgical myocardial revascularization: Long-term clinical follow-up. J Cardiothorac Surg. 10:1272015. View Article : Google Scholar : PubMed/NCBI
11	Aydin S, Aydin S, Eren Nesimi M, Sahin I, Yilmaz M, Kalayci M and Gungor O: The cardiovascular system and the biochemistry of grafts used in heart surgery. Springerplus. 2:6122013. View Article : Google Scholar : PubMed/NCBI
12	Buxton BF and Hayward PA: The art of arterial revascularization-total arterial revascularization in patients with triple vessel coronary artery disease. Ann Cardiothorac Surg. 2:543–551. 2013.PubMed/NCBI
13	Drouin A, Noiseux N, Chartrand-Lefebvre C, Soulez G, Mansour S, Tremblay JA, Basile F, Prieto I and Stevens LM: Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: Study protocol for a randomized controlled trial. Trials. 14:2702013. View Article : Google Scholar : PubMed/NCBI
14	Ohira S, Doi K, Okawa K, Dohi M, Yamamoto T, Kawajiri H and Yaku H: Safety and efficacy of sequential left internal thoracic artery grafting to left circumflex area. Ann Thorac Surg. 102:766–773. 2016. View Article : Google Scholar : PubMed/NCBI
15	Porto I, Gaudino M, De Maria GL, Di Vito L, Vergallo R, Bruno P, Bonalumi G, Prati F, Bolognese L, Crea F and Massetti M: Long-term morphofunctional remodeling of internal thoracic artery grafts: A frequency-domain optical coherence tomography study. Biomed Eng Online. 6:269–276. 2013.
16	Ghista DN and Kabinejadian F: Coronary artery bypass grafting hemodynamics and anastomosis design: A biomedical engineering review. Biomed Eng Online. 12:1292013. View Article : Google Scholar : PubMed/NCBI
17	Li H, Xie B, Gu C, Gao M, Zhang F, Wang J, Dai L and Yu Y: Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow. BMC Cardiovasc Disord. 14:652014. View Article : Google Scholar : PubMed/NCBI
18	Dion R, Glineur D, Derouck D, Verhelst R, Noirhomme P, El Khoury G, Degrave E and Hanet C: Long-term clinical and angiographic follow-up of sequential internal thoracic artery grafting. Eur J Cardiothorac Surg. 17:407–714. 2000. View Article : Google Scholar : PubMed/NCBI
19	Calafiore AM, Contini M, Vitolla G, Di Mauro M, Mazzei V, Teodori G and Di Giammarco G: Bilateral internal thoracic artery grafting: Long-term clinical and angiographic results of in situ versus Y grafts. J Thorac Cardiovasc Surg. 120:990–996. 2000. View Article : Google Scholar : PubMed/NCBI
20	Tatoulis J, Buxton BF and Fuller JA: Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg. 77:93–101. 2004. View Article : Google Scholar : PubMed/NCBI
21	Fukui S, Fukuda H, Toda K, Yoshitatsu M, Funatsu T, Masai T and Miyamoto Y: Remodeling of the radial artery anastomosed to the internal thoracic artery as a composite straight graft. J Thorac Cardiovasc Surg. 134:1136–1142. 2007. View Article : Google Scholar : PubMed/NCBI
22	Taggart DP: Current status of arterial grafts for coronary artery bypass grafting. Ann Cardiothorac Surg. 2:427–430. 2013.PubMed/NCBI
23	Mukherjee D, Cheriyan J, Kourliouros A and Athanasiou T: Does the right internal thoracic artery or saphenous vein graft offer superior revascularization of the right coronary artery? Interact Cardiovasc Thorac Surg. 15:244–247. 2012. View Article : Google Scholar : PubMed/NCBI
24	Jung SH, Song H, Choo SJ, Je HG, Chung CH, Kang JW and Lee JW: Comparison of radial artery patency according to proximal anastomosis site: Direct aorta to radial artery anastomosis is superior to radial artery composite grafting. J Thorac Cardiovasc Surg. 138:76–83. 2009. View Article : Google Scholar : PubMed/NCBI
25	Song MH, Sato M and Ueda Y: Three-dimensional simulation of coronary artery bypass grafting with the use of computational fluid dynamics. Surg Today. 30:993–998. 2000. View Article : Google Scholar : PubMed/NCBI
26	Staalsen NH, Ulrich M, Winther J, Pedersen EM, How T and Nygaard H: The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo. J Vasc Surg. 21:460–471. 1995. View Article : Google Scholar : PubMed/NCBI
27	Frauenfelder T, Boutsianis E, Schertler T, Husmann L, Leschka S, Poulikakos D, Marincek B and Alkadhi H: Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts. Biomed Eng Online. 6:352007. View Article : Google Scholar : PubMed/NCBI
28	Fei DY, Thomas JD and Rittgers SE: The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses: A numerical model study. J Biomech Eng. 116:331–336. 1994. View Article : Google Scholar : PubMed/NCBI
29	Sherwin SJ, Doorly DJ, Franke P and Peiró J: Unsteady near wall residence times and shear exposure in model distal arterial bypass grafts. Biorheology. 39:365–371. 2002.PubMed/NCBI
30	Bonert M, Myers JG, Fremes S, Williams J and Ethier CR: A numerical study of blood flow in coronary artery bypass graft side-to-side anastomoses. Ann Biomed Eng. 30:599–611. 2002. View Article : Google Scholar : PubMed/NCBI
31	Tremblay JA, Stevens LM, Chandonnet M, Soulez G, Basile F, Prieto I, Noiseux N and Chartrand-Lefebvre C: A morphometric 3D model of coronary artery bypass graft dysfunction with multidetector computed tomography. Clin Imaging. 39:1006–1011. 2015. View Article : Google Scholar : PubMed/NCBI