Role of prosthetic conduits in coronary artery bypass grafting

Abstract

Prosthetic grafts are required for coronary artery bypass grafting (CABG) when the availability of suitable autologous conduits is limited. The ideal cardiovascular bypass graft requires a broad range of characteristics including strength, viscoelasticity, biocompatibility, blood compatibility and biostability. Many alternative conduits have been developed and used in the past, but most of them have failed, except in rare instances. This review aims to analyse the current status of their use and prospects for the future. We performed a literature search on PubMed using the generic terms 'conduits for coronary artery bypass grafting'; 'reoperative coronary artery bypass grafting'; 'redo coronary artery bypass grafting'; 'PTFE'; 'Dacron or PET'; 'gastroepiploic artery'; 'inferior epigastric artery'; 'biological grafts'; 'tissue-engineered grafts'; 'synthetic grafts'; 'prosthetic grafts'; 'polyurethane grafts'; 'cephalic veins'; 'short saphenous vein;' and 'alternative conduits'. In addition, we searched through related citations and references from selected articles. A total of 1253 references and 110 full-text articles were reviewed, and they were further selected based on available information. This review concludes that, over the past three to four decades, achieving the goal of a prosthetic graft with equivalent function and durability to the internal mammary artery or long saphenous vein has proved to be elusive.

Ten-year patency of functionally expanded polytetrafluoroethylene coronary graft detected in an urgent cardiac surgery

“…However, the use of ePTFE grafts for CABG surgery is usually not proposed because of their lower patency rates. [1,2] However, it must be noted that the majority of the studies on the use of ePTFEs were done approximately 30 years ago, and the three-year patency rate at that time was 14%. [5] The ePTFE is an inert fluorocarbon polymer with an electronegative luminal surface.…”

“…The internal thoracic artery and greater saphenous vein are the first-line conduit choices, but the short saphenous vein, upper extremity veins, radial artery, and stated visceral arteries have been used in some cases. [1,4] However, there is limited availability of these grafts, especially for reoperations, and the associated comorbidities have led to the necessity of distinct bypass conduits, including those that are synthetic. The ePTFE graft is one of the well-known synthetic conduits that has been widely used in peripheral surgery with satisfactory long-term results.…”

“…In addition, the lumen of the ePTFE also lacks an endothelial cell lining which contributes to its poor patency. [1] In cases in which other conduits are unavailable, hybrid therapy is often suggested before the use of ePTFE grafts. [1] Thus, ePTFE grafts are generally proposed as a last resort for a CABG conduit, and this is also true at our facility.…”

“…Acil kalp cerrahisi sırasında saptanan on yıllık fonksiyonel olarak genişletilmiş politetrafloroetilen koroner greft açıklığı Bülent Uzunlar, 1 Ahmet Karabulut, 1 Zeki Doğan, 1 Batuhan Özay 2 Fonksiyonel olarak genişletilmiş politetrafloroetilen (ePTFE) greftler, düşük açıklık oranları nedeniyle koroner kondüit olarak tercih edilmemektedir. Bu yazıda, ePTFE koroner kondüit ile 10 yıl önce ameliyat olan 69 yaşında bir erkek olgu sunuldu.…”

“…Although prosthetic and synthetic grafts are widely used in peripheral bypass operations, they are still the last resort in CABG because of their low patency rate. [1] Herein, we present a case of coronary bypass graft perforation as a complication after percutaneous intervention. During urgent surgery, it was confirmed that the bypass conduit was actually an expanded polytetrafluoroethylene (ePTFE) graft which coronary angiography had indicated was a probable venous graft.…”