Current Trends in Surgical Revascularization of Multivessel Coronary Artery Disease With Arterial Grafts

Nicolini, Francesco; Agostinelli, Andrea; Spaggiari, I; Vezzani, Antonella; Benassi, Filippo; Maestri, Francesco; Gherli, Tiziano

doi:10.1536/ihj.14-010

Cited by 10 publications

(7 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence has shown that the use of composite Y/T grafts to avoid any manipulation of the diseased ascending aorta results in a low stroke rate. Although OPCAB with total arterial revascularization has been proposed as the gold standard approach to reduce neurocognitive dysfunction only for patients with severe atherosclerosis, 10,22) this no-touch procedure may not be routinely applied, particularly in emergent cases. Left ITA to Y graft anastomosis is more technically demanding than that of the ascending aorta and can result in a potential steal phenomenon of the left ITA by the anastomosed graft because most of the coronary circulation is supplied through a single inflow from the left ITA.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

et al. 2019

View full text Add to dashboard Cite

Severe aortic atherosclerosis is a risk factor for stroke during coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the incidence of postoperative neurologic complications after off-pump CABG (OPCAB) with a proximal seal system (Heartstring). From January 2011 to December 2014, 729 patients underwent isolated OPCAB. The cohort was divided into two groups (Heartstring [HS] and aortic no-touch [NT]). The severity of aortic atherosclerosis (Katz grade) was evaluated by intraoperative epiaortic ultrasonography (EUS). The primary endpoints were postoperative neurologic complications (early stroke and minor events (delirium, transient ischemic attack, and syncope)), and the secondary endpoints were late major adverse cardiac and cerebrovascular events (MACCEs) and death. The mean age of all patients was 65.1 ± 9.5 years, and a severe Katz grade (IV or V) was demonstrated to be an independent risk factor of long-term mortality (HR 3.53; 95% CI 1.06-11.75; P = 0.04) and MACCEs (HR 2.41; 95% CI 1.19-4.92; P = 0.02), but no significant differences were found for early stroke (0.9% versus 1.7%; P = 0.53) and minor neurologic complications (14.6% versus 9.9%; P = 0.05) between the groups regardless of the Katz grade. The 5-year overall survival rate did not differ significantly between the groups (90.9% versus 87.6%; P = 0.61). Although a higher Katz grade was identified as an independent risk factor of death and MACCEs, the HS group was not inferior in terms of neurologic complications regardless of the Katz grade. Therefore, the Heartstring system might be safely and efficiently used with EUS to decrease the incidence of neurologic complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

et al. 2019

View full text Add to dashboard Cite

show abstract

“…When anastomosed to the left anteri-Vol 56 No 3 LITA GRAFT DISSECTION ASSESSED BY OCT AND IVUS or descending artery, LITA grafts are very favorable over a 10-year period. 1,2) The most common site of stenosis in the LITA graft is the distal anastomosis. 4) On the other hand, graft failure of LITA itself is rare but can occur.…”

Section: Discussionmentioning

confidence: 99%

“…1,2) The characteristics of the LITA including its elastomuscular composition and its well-known resistance to atherosclerosis are thought mainly to account for these favorable results.…”

mentioning

confidence: 99%

Spontaneous Spiral Dissection of Left Internal Thoracic Artery Graft

et al. 2015

View full text Add to dashboard Cite

SummaryThe left internal thoracic artery (LITA) is considered the most reliable coronary artery bypass grafting conduit due to its high rate of long-term patency. LITA grafts are extremely durable and associated complications are infrequent. We present a case with spontaneous spiral dissection of a LITA graft to the left anterior descending artery, which was assessed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). OCT was superior in visualizing the disrupted flap, false lumen, and intramural hematoma, but it did not visualize the full extent of the vessel wall. In contrast, IVUS allowed more complete and deeper vessel visualization, and thus better appreciation of the extent of intramural hematoma. Combined use of these two modalities provides complementary details on imaging of a LITA dissection. (Int Heart J 2015; 56: 360-362)

show abstract

“…Another 14 patients died within 13 months to five years following surgery, and the causes of death included myocardial infarction (2), heart failure (3), infection (4), hepatic failure (1), gastrointestinal hemorrhage (1) and malignant tumor (3). Over five years after surgery, 25 patients died; the main causes of death were listed as follows: myocardial infarction (3), heart failure (4), cerebral hemorrhage (2), gastrointestinal hemorrhage (1), infection (5), renal failure (1), malignant tumor (6), high falling injury (1) and traffic accident (2). Additionally, 16 patients underwent repeat revascularization, with the incidence of 5.4%.…”

Section: Study Populationmentioning

confidence: 99%

“…1) Afterwards, RA graft re-patency following early vasospasm and functional occlusion was found, wakening cardiac surgeons' interest in the RA grafting. 2) Subsequently, the use of the RA as a bypass conduit for CABG was increasing.…”

mentioning

confidence: 99%

Long-Term Patency Rate of Radial Artery Conduits in Chinese Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Song²,

Shen

et al. 2019

Int. Heart J.

View full text Add to dashboard Cite

Consensus has yet to emerge among experts as to whether the radial artery (RA) conduit was superior to the saphenous vein (SV) graft for coronary artery bypass grafting (CABG) in terms of long-term patency. This study aimed to evaluate long-term patency of the RA conduit compared to the SV conduit for off-pump CABG, and to screen the independent predictors of long-term RA graft failure. Patients < 80 years of age with graftable triple-vessel disease undergoing non-emergent, primary, isolated off-pump CABG, using both the RA and the SV conduits, were reviewed. Graft patency, all-cause mortality and repeat revascularization were followed-up. The independent predictors of long-term RA graft failure were identified. A total of 296 out of 320 eligible patients (42 females, 61.3 ± 9.9 years old) received follow-up with an observed period of 93.4 ± 16.5 months. All-cause mortality was 14.5%, and repeat revascularization was conducted on 6 RA grafts and 9 SV grafts. Superior patency of the RA grafts compared to the SV grafts was observed (84.4% versus 78.5%, P = 0.035). Independent predictors of long-term RA graft failure included proximal stenosis of target right coronaries < 90% (OR = 2.35, 95%CI 1.41-5.82) and diabetes mellitus (OR = 1.66, 95%CI 1.17-4.26). The RA graft had a superior long-term patency than the SV graft. Long-term patency of the RA graft may be poor in diabetics or in the case of proximal stenosis of target right coronary <90%.

show abstract

Current Trends in Surgical Revascularization of Multivessel Coronary Artery Disease With Arterial Grafts

Cited by 10 publications

References 57 publications

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

Effects of a Proximal Seal System on Neurologic Outcomes of Off-Pump Coronary Artery Bypass Grafting

Spontaneous Spiral Dissection of Left Internal Thoracic Artery Graft

Long-Term Patency Rate of Radial Artery Conduits in Chinese Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Contact Info

Product

Resources

About