Current trends in selection of conduits for coronary artery bypass grafting

Carrel, Thierry; Winkler, Bernhard

doi:10.1007/s11748-017-0807-8

Cited by 23 publications

(17 citation statements)

References 66 publications

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“…Due to acute thrombosis patency rates of vein grafts decrease with 10% within the first month ( 1 ). Intimal hyperplasia and accelerated atherosclerosis lead to a 40% overall patency after 10–20 years, Figures 1 B,C ( 8 , 9 ). Risk factors associated with vein graft disease (VGD) include age, race, gender, hypercholesterolemia, diabetes mellitus, and chronic kidney disease ( 10 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Inflammation in Vein Graft Disease

Vries

Quax

2018

Front. Cardiovasc. Med.

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Bypass surgery is one of the most frequently used strategies to revascularize tissues downstream occlusive atherosclerotic lesions. For venous bypass surgery the great saphenous vein is the most commonly used vessel. Unfortunately, graft efficacy is low due to the development of vascular inflammation, intimal hyperplasia and accelerated atherosclerosis. Moreover, failure of grafts leads to significant adverse outcomes and even mortality. The last couple of decades not much has changed in the treatment of vein graft disease (VGD). However, insight is the cellular and molecular mechanisms of VGD has increased. In this review, we discuss the latest insights on VGD and the role of inflammation in this. We discuss vein graft pathophysiology including hemodynamic changes, the role of vessel wall constitutions and vascular remodeling. We show that profound systemic and local inflammatory responses, including inflammation of the perivascular fat, involve both the innate and adaptive immune system.

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Section: Introductionmentioning

confidence: 99%

Inflammation in Vein Graft Disease

Vries

Quax

2018

Front. Cardiovasc. Med.

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“…For example, when the revascularised area of posterior-descending branch is small, sequential grafting to posterior-descending branch in a side-to-side fashion, and to circumflex branch with good run-off in an end-to-side fashion can be beneficial. Carrel and colleagues stated that the patency of the GEA was not always superior to that of the SVG for RCA; therefore, appropriate conduit selection would improve the overall graft patency [22].…”

Section: Discussionmentioning

confidence: 99%

Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand

Nakajima

Takazawa

Yoshitake

et al. 2019

Gen Thorac Cardiovasc Surg

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Objectives We investigated current mechanisms causing low graft flow (LGF) following coronary artery bypass grafting, particularly for the right coronary artery (RCA). Methods We retrospectively assessed 230 individual bypass grafts as the sole bypass graft for the RCA using preoperative and postoperative quantitative angiography. Overall, 155 in-situ gastroepiploic arteries (GEAs) and 75 saphenous vein grafts (SVGs) were included. The size and status of the revascularised area were examined to determine whether these factors were associated with LGF (defined as ≤ 20 mL/min with intraoperative flowmetry). A distal lesion was defined as stenosis at segment #4, whereas a proximal lesion was stenosis at #1, #2 and #3. Results Graft flow in the SVG and the GEA for distal lesion was significantly less compared with that for proximal lesion (34 ± 26 vs. 60 ± 46, p < 0.0001 and 22 ± 12 vs. 43 ± 28, p = 0.0004, respectively). For proximal lesion, LGF was significantly more frequent when the minimal luminal diameter was over 1.27 compared with when it was less than 1.27 (p = 0.02). Prior myocardial infarction significantly correlated with LGF in the GEA (p = 0.007) and the SVG (p = 0.03). In 55 bypass grafts with LGF, the causes were competitive flow in 20.0%, small revascularised area in 38.1% and prior myocardial infarction in 32.7%. Conclusions Along with the current strategy based on the severity of native coronary stenosis, the incidence of competitive flow decreased remarkably. This resulted in flow demand, myocardial status and collateral vessels more influential on graft patency.

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“…Treatment of established disease includes surgical resection of affected vessels following implantation of a vascular graft. Autologous blood vessels used as autografts are the best option for such surgery; however, their availability is frequently limited and harvesting such vessels is associated with risk of complications [2,3]. Currently available artificial prostheses with a diameter of <6 mm tend to develop thrombosis and neointimal hyperplasia in the long-term [4,5].…”

Section: Introductionmentioning

confidence: 99%

A Brief Report on an Implantation of Small-Caliber Biodegradable Vascular Grafts in a Carotid Artery of the Sheep

et al. 2020

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The development of novel biodegradable vascular grafts of a small diameter (<6 mm) is an unmet clinical need for patients requiring arterial replacement. Here we performed a pre-clinical study of new small-caliber biodegradable vascular grafts using a sheep model of carotid artery implantation. The 4 mm diameter vascular grafts were manufactured using a mix of polyhydroxybutyrate/valerate and polycaprolactone supplemented with growth factors VEGF, bFGF and SDF-1α (PHBV/PCL-GFmix) and additionally modified by a polymer hydrogel coating with incorporation of drugs heparin and iloprost (PHBV/PCL-GFmixHep/Ilo). Animals with carotid artery autograft implantation and those implanted with clinically used GORE-TEX® grafts were used as control groups. We observed that 24 h following surgery, animals with carotid artery autograft implantation showed 87.5% patency, while all the PHBV/PCL-GFmix and GORE-TEX® grafts displayed thrombosis. PHBV/PCL-GFmixHep/Ilo grafts demonstrated 62.5% patency 24 h following surgery and it had remained at 50% 1 year post-operation. All the PHBV/PCL grafts completely degraded less than 1 year following surgery and were replaced by de novo vasculature without evidence of calcification. On the other hand, GORE-TEX® grafts displayed substantial amounts of calcium deposits throughout graft tissues. Thus, here we report a potential clinical usefulness of PHBV/PCL grafts upon their additional modification by growth factors and drugs to promote endothelialization and reduce thrombogenicity.

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Current trends in selection of conduits for coronary artery bypass grafting

Cited by 23 publications

References 66 publications

Inflammation in Vein Graft Disease

Inflammation in Vein Graft Disease

Current mechanisms of low graft flow and conduit choice for the right coronary artery based on the severity of native coronary stenosis and myocardial flow demand

A Brief Report on an Implantation of Small-Caliber Biodegradable Vascular Grafts in a Carotid Artery of the Sheep

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