The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Abstract

The use of the left internal mammary artery (IMA) has been shown to improve longterm survival and has been a gold standard in coronary artery bypass grafting (CABG). However, the choice of second or third graft conduit is still controversial. Multiple studies demonstrated the beneit of using multiple arterial grafts such as right IMA and radial artery in addition to left IMA in terms of long-term survival and graft patency. However, most of the centers still perform CABG with one IMA and vein grafts in a real world. The challenges for bilateral IMA utilization include longer operative time and concerns for higher rates of perioperative morbidity and mortality associated with increased sternal wound infection. Several studies reported that skeletonization technique can reduce the risk of sternal wound infection. Radial artery is another arterial conduit, which does not increase the risk of sternal wound infection and is easy to harvest. The superiority between radial artery and right IMA has been controversial. In the meantime, multiple trials have been made to improve the patency of vein grafts. The choice of graft conduits in CABG should be well considered preoperatively based on each patient's backgrounds.

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“…The findings of the study displayed that SV+IMA was the most frequently used Graft in the surgical management of Ischemic Heart Disease. This could be explained that the SV is the most frequent used conduit and IMA is the most optimal type of graft [23]. It was also found that (CABG + 3 Grafts) was the most frequent surgeries done for ischemic heart disease patients in Al-Thawrah Hospital.…”

Renal dysfunction in adults following cardiopulmonary bypass is linked to declines in S-Nitrosylated hemoglobin – a case series

“…Each year in the United States, hundreds of thousands of patients undergo cardiopulmonary bypass (CPB) 1 , 2 ; coronary artery bypass grafting (CABG) alone accounts for ~400 000 of these procedures 3 . Developed in the 1960s, use of CPB is now viewed as routine by the lay public.…”

Factors Associated with Acute Pulmonary Embolism in Patients with Hypoxia After off-Pump Coronary Artery Bypass Grafting: A Case-Control Study

“…Coronary artery bypass grafting (CABG) is considered the most effective surgical intervention for myocardial revascularization among individuals afflicted with coronary artery disease (CAD), imparting a substantial enhancement to patients’ quality of life and a prolonged lifespan. 1 , 2 In contrast, the off-pump coronary artery bypass grafting (OPCABG) technique circumvents multiple adverse physiological effects, including water and electrolyte imbalances, disturbances in acid-base equilibrium, erythrocyte and platelet deterioration, stress-related responses, and ischemia-reperfusion injury, consequently amplifying the success rate of the procedure. 2 The occurrence of hypoxia following coronary artery bypass surgery is not an infrequent event.…”