Critical Analysis of Coronary Artery Bypass Graft Surgery: A 30-Year Journey

Favaloro, René G.

doi:10.1016/s0735-1097(97)00559-7

Cited by 112 publications

(76 citation statements)

References 847 publications

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“…It is estimated that only in the United States more than 500,000 of such operations are performed per year, and in the whole world this number is close to 800,000 [1]. It is known that since the beginning of the surgical treatment of myocardial ischemia for almost four decades, such procedure has become, alone, one of the most performed and studied procedures in the contemporary history of surgery [2,3]. Even with the use of arterial grafts, the saphenous vein is still the most used conduit, and complications that occur in the operated limb have been underestimated and has not been properly studied and developed [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio

Belczak

Tyszka²,

Godoy³

et al. 2009

Rev Bras Cir Cardiovasc

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Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdioClinical complications of limb undergone harvesting of great saphenous vein for coronary artery bypass grafting using bridge technique Abstract Objective: The aim of this study was to assess clinical complications of limbs undergone harvesting of the great saphenous vein for venous coronary artery bypass graft surgery using bridge technique.Methods: Fourty-four patients who had undergone CABG using the great saphenous vein harvested by the bridge technique over more than 3 months ago were randomly selected. The exclusion criteria were the harvesting of both saphenous veins, prior saphenectomy of the contralateral limb, edema caused by a systemic etiology, such as heart, renal, thyroid or hepatic diseases and venous insufficiency of the lower limbs as characterized by swollen varicose veins both with and without trophic changes. The age, gender, diabetes, time of surgery and occurrence of complications, such as edema, paresthesia, infection, lymphorrhea, erysipelas and deep venous thrombosis, were assessed. The assessment was clinic and diagnosis of the diabetes was performed by the preoperative exams. The chisquare, Fisher and Student's t tests were used for statistical analysis with an alpha error of 5%.Results: The time between surgery and assessment ranged between 3 and 187 months with a mean of 47.3±42.5 months. Infections of the saphenous harvest site were detected in 25% of the cases, edema in 52.3%, paresthesia in 29.5%, erysipelas in 9.1%, lymphorrhea in 4.5% and deep venous thrombosis in 2.3%. There was no association between diabetes and complications.Conclusion: The saphenous vein harvesting using bridge technique for coronary artery bypass grafting does not eliminate clinical complications, such as paresthesia, infection and edema of the saphenous vein harvesting site. Descriptors:Saphenous vein. Myocardial revascularization. Postoperative complications/etiology. Coronary artery bypass/methods. ResumoObjetivo: Avaliar as intercorrências clínicas nos membros submetidos a retirada da veia safena magna por técnica de incisões escalonadas para sua utilização como enxerto venoso na revascularização do miocárdio.Métodos: Selecionou-se aleatoriamente 44 pacientes submetidos a revascularização do miocárdio utilizando a veia safena magna retirada por incisões escalonadas há mais de 3 meses. Critérios de exclusão: retirada da veia safena de ambos os lados; safenectomia prévia do membro contralateral; etiologias de edema de causas sistêmicas, tais como cardíacas, This study was carried out at the Clinics of Cardiac Surgery of Maringá, PR.

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Section: Introductionmentioning

confidence: 99%

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio

Belczak

Tyszka²,

Godoy³

et al. 2009

Rev Bras Cir Cardiovasc

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“…This patient population is one of the most controversial, from an outcome perspective. Early registry studies comparing PTCA and CABG showed a trend toward improved survival following surgical revascularization in this patient population (17)(18)(19)(20)(21). However, RCTs from the PCI era, which used stents and GP IIb/IIIa inhibitors, are conflicting.…”

Section: Pci Versus Cabgmentioning

confidence: 99%

“…Several registry studies comparing balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) and CABG showed a trend toward improved survival following surgical revascularization in this patient population (18)(19)(20)(21). However, RCTs from the PCI era, which used stents and glycoprotein (GP) IIb/IIIa inhibitors, are conflicting.…”

Section: Ou Pontage Aortocoronarien [Pac])mentioning

confidence: 99%

Outcomes of revascularization strategies for two-vessel coronary artery disease involving the proximal left anterior descending artery in an era of improved pharmacotherapy and stenting

Hubáček

Kalla

Galbraith

et al. 2008

Canadian Journal of Cardiology

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“…Autologous saphenous vein is used as a conduit to bypass atherosclerotic lesions both in the coronary artery (coronary artery bypass grafting (CABG)) [1][2][3][4] and in femoral arteries (infrainguinal bypass graft surgery). Even with the rapid development of intracoronary stents, certain advantages of CABG over percutaneous coronary intervention (PCI) are likely to continue in the foreseeable future, particularly in diabetic patients and in those with left main and multivessel coronary diseases.…”

Section: Clinical Use Of Autologous Saphenous Veinmentioning

confidence: 99%

Vein graft failure: current clinical practice and potential for gene therapeutics

et al. 2012

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Autologous saphenous vein is commonly used as a conduit to bypass atherosclerotic lesions in coronary and femoral arteries. Despite the wide use of arterial conduits, which are less susceptible to complications and failure, as alternative conduits, the saphenous vein will continue to be used in coronary artery bypass grafting until acceptable alternative approaches are evaluated. Hence, preservation of vein graft patency is essential for the long-term success. Gene therapy is attractive in this setting as an ex-vivo technology to genetically manipulate the conduit before grafting. The use of safe and efficient vectors for delivery is a necessity as well as a strategy to improve patency in the long term. Here, we review the current clinical practice, the pathogenesis of bypass graft failure and adenovirus-mediated gene therapy strategies designed to improve late vein graft failure by modulation of smooth muscle cells in the vein wall.

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Critical Analysis of Coronary Artery Bypass Graft Surgery: A 30-Year Journey

Cited by 112 publications

References 847 publications

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio

Intercorrências clínicas no membro submetido à exérese de veia safena magna para revascularização do miocárdio

Outcomes of revascularization strategies for two-vessel coronary artery disease involving the proximal left anterior descending artery in an era of improved pharmacotherapy and stenting

Vein graft failure: current clinical practice and potential for gene therapeutics

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