Coronary artery bypass grafting (CABG) remains the most common operation performed by cardiac surgeons today. Fundamental basis of CABG is to reestablish perfusion to the myocardium, however there are different approaches in accomplishing this goal. The collection of scientific publications suggest the use of multiple arterial conduits in patients of young age, preferable without advanced comorbidity and low body surface area. Despite common use of saphenous vein grafts, lots publications demonstrate advantages of arterial conduits. Internal mammary artery (IMA) has patency rates in the region of 90–95% ten to fifteen years after CABG. Based on superior long-term results of the internal mammary artery (IMA), other arteries is being used in CABG. Radial artery (RA) nowadays it is the most popular arterial graft after the IMA in both low- and high-risk patients. Although, this conduit is underused, despite numerous observational studies, which documented excellent RA patency of 89% at 10 years. Furthermore RA and ITA grafting shows a strong protective effect against native coronary artery disease progression in symptomatic patients after CABG. The constellation of recent data and 2018 guidelines of European Society of Cardiology and European Association for Cardiothoracic Surgeons on myocardial revascularization suggest performing total arterial revascularization in patients with multi-vessel coronary artery disease. Purpose. Literature review on recent data in surgical revascularization using multiple arterial grafts in patients with multi-vessel coronary artery disease. Conclusions. Total arterial revascularization is safe and effective method in treatment of multi-vessel coronary artery disease. There is undoubted benefit of total arterial revascularization in short-, mid- and long–term results in frames of angina recurrence, major adverse cardiac events and redo surgery, associated with graft failure, compared to saphenous vein grafts. Total arterial revascularization may have protective effect on native coronary artery from disease progression, along with excellent patency rates in patients after CABG. However, clinical choice of grafts should be based on patient’s general condition, coronary artery anatomy and severity of stenosis.
The paper presents review of the literature in terms of the advantages of no-touch great saphenous vein (GSV) harvesting technique and its impact on long-term GSV patency for coronary artery bypass grafting compared to conventional method of vein harvesting. Presented detailed pathophysiological mechanisms of venous graft failure, using conventional GSV harvesting. Purpose. Analysis of literature data for the optimal choice of additional vascular shunt used for coronary bypass grafting in multi – vessel coronary artery disease, based on patency rate. Conclusion. No-touch technique of GSV harvesting provides better structural, functional, and mechanical protection of the vein wall. Perfecting the technique of this harvesting method and long-term follow up in patients with no-touch GSV grafts may reveal a graft patency comparable to that of LITA.
Вісник серцево-судинної хірургії 2018 ішемічна хвороба серцяCoronary revascularization provides symptomatic relief from coronary artery disease (CAD) and improves short and long-term outcomes in patients with CAD. The optimal revascularization strategy is still controversial among interventional and conventional approaches for coronary revascularization, although coronary artery bypass grafting (CABG) remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with percutaneous interventions (PCI), resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events (MACE) at 1 year according to SYNTAX study (SYNergy Between PCI With TAXus and Cardiac Surgery). The optimal revascularization strategy should combine a minimally invasive surgical procedure that reduces perioperative risk, while maximizing long-term patency of conduit for CABG along with patient's survival rates.Hybrid coronary revascularization (HCR) was first introduced in 1996 [1] as a promise to full coronary artery revascularization minimizing surgical trauma and adverse cardiovascular events. The initial concept was launched by Dr. Gianni from Imperial college of London and included small number of patients, who received favorable outcomes in terms of hospital stay, duration of extubation and 6-month period survival. The hybrid approach refers to the combination of CABG and PCI, namely providing anastomosis of left internal mammary artery (LIMA) to left anterior descending artery (LAD), typically via minimally invasive technique and PCI for remaining (non-LAD) vessels.The rationale for HCR lies in the well-established survival benefit conferred by LIMA-to-LAD grafts and the use of new DES-stent platforms featuring low stent restenosis and thrombosis rates compared with venous graft stenosis and occlusion rates [2]. The superior patency of LIMAto-LAD graft provides prophylaxis against future proximal LAD lesions, which translates into better event-free survival and relief of angina. The benefits of bypassing other non-LAD coronary vessels are much less clear. Conduits for a non-LAD vessel may include other arterial grafts (complete arterial revascularization), but the saphenous vein is by far the most commonly used. A major limitation of CABG with great saphenous vein grafts (GSV) lies in the high graft failure rates with reports ranging from 13% to 29% at 1 year and up. Newer drug-eluting stent (DES) platforms with (e.g., everolimus-eluting stents (EES) or zotarolimus-eluting stents (ZES) or without (bioresorbable polymer-based or polymer-free stents) durable polymers show favorable outcomes, with 1-year target lesion revascularization (TLR) rates as low as 3% to 3.25% [4]. Even in high-risk patients and complex lesions, ZES and EES maintain very low 1-year TLR rates of 4.4% and 4%, respectively [5]. Thus, PCI and stenting provide strong competition for SVG revascularization because, unlike an LIMA-LAD graft, disease progression in the proxi...
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