Critical Analysis of the Preoperative and Operative Predictors of Aortocoronary Bypass Patency

Abstract

A prospective analysis of the angiographic and operative anatomic and reconstructive variables that influenced graft patency was undertaken at the University of Virginia Medical Center in 50 consecutive patients. Postoperative restudy showed that 18 of the 168 grafts performed were occluded due to venous disease, inadequate run-off, or sequential design error. Angiographic artery size was 27% larger than operative estimations; graft patency significantly increased with increasing distal artery diameter, with decreasing venous conduit diameter, and with good graftability rating of the vessels preoperatively. Ejection fraction, the degree of arterial stenosis, and the source of the saphenous vein conduit (the thigh or the lower leg) had no influence on graft patency. Simple grafts had a 96% patency, while sequential grafts had an 80% patency. When design error for sequential grafts was eliminated, the sequential patency rate rose to 88%. For revascularization of small circumflex vessels, consideration should be given to variation in the sequential grafting technique to improve patency in these vessels.

Outcomes of small coronary artery stenting with bare‐metal stents versus drug‐eluting stents: Results from the NHLBI dynamic registry

“…In our study, women comprised 41% of patients receiving small coronary artery stents and diabetics 35%. Additionally, patients with small coronary arteries undergoing CABG are at higher risk for complications including poor graft patency and mortality than patients with larger reference vessel diameter.…”

Fractional flow reserve of pedicled internal thoracic artery and saphenous vein grafts 6 months after bypass surgery

“…The longterm patency of the left ITA has always been found superior to that of the right ITA, even when implanted on the LAD [6,7]. Since the two ITA's are supposed to be identical in terms of anatomy and physiology, this difference has been mainly explained by differences in the quality of the run off of the targeted vessel [8].…”

Single photon emission tomography imaging of myocardial oxidative metabolism with 15-(p-[123I]iodophenyl) pentadecanoic acid in patients with coronary artery disease and aorto-coronary bypass graft surgery

“…There are reports concerning restitution of flow (Block 1985;Crosby et al 1981;Faxon et al 1984;Hamby et al 1979), but little is known about the biochemical consequences of reperfusion (Gropler et al 1990;Visser et al 1985;Zimmermann et al 1987). There is clinical and experimental evidence demonstrating slow recovery of regional wall motion of reperfused myocardium (O'Keefe et al 1988;Schwaiger et al 1985).…”