Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Filho, Heraldo Guedis Lobo; Filho, José Glauco Lobo; Pimentel, Matheus Duarte; Silva, Bruno Gadelha Bezerra; Souza, Camylla Santos de; Montenegro, Marilia; Leitão, Maria Cláudia de Azevedo; Jamacuru, Francisco Vagnaldo Fechine

doi:10.5935/1678-9741.20160053

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Incorporating sequential side-to-side anastomoses may improve blood flow in side-to-side targets, whereby distal segments may be more sensitive to competitive flow and require a lower fractional flow reserve for functional patency [ 53 ]. In other intraoperative analyses of blood flow comparing coronary graft flow with side-to-side patent sequential anostomoses with flow under temporary occlusion, there were no differences in terminal coronary flow in left- [ 54 ] or right-sided targets [ 55 ], highlighting the need for further study. These hemodynamic data suggest that composite grafts may be comparable to non-composite grafts at intraoperative assessment and potentially superior in selected circumstances.…”

Section: Techniques and Anastomoses For Arterial Graftingmentioning

confidence: 99%

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Vervoort

Elbatarny

Rocha

et al. 2023

JCM

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Ischemic heart disease is the leading cause of morbidity and mortality worldwide and may require coronary revascularization when more severe or symptomatic. Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure and can be performed with different bypass conduits and anastomotic techniques. Saphenous vein grafts (SVGs) are the most frequently used conduits for CABG, in addition to the left internal thoracic artery. Outcomes with a single internal thoracic artery and SVGs are favorable, and the long-term patency of SVGs may be improved through novel harvesting techniques, preservation methods, and optimal medical therapy. However, increasing evidence points towards the superiority of arterial grafts, especially in the form of multiple arterial grafting (MAG). Nevertheless, the uptake of MAG remains limited and variable, both as a result of technical complexity and a scarcity of conclusive randomized controlled trial evidence. Here, we present an overview of CABG techniques, harvesting methods, and anastomosis types to achieve total arterial revascularization and adopt MAG. We further narratively summarize the available evidence for MAG versus single arterial grafting to date and highlight remaining gaps and questions that require further study to elucidate the role of MAG in CABG.

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Section: Techniques and Anastomoses For Arterial Graftingmentioning

confidence: 99%

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Vervoort

Elbatarny

Rocha

et al. 2023

JCM

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“…In the literature, there are only few publications on studies in coronary patients with an arteriovenous Y-or T-graft between the LIMA and the saphenous vein (SV) for surgical myocardial revascularization. [8][9][10][11][12][13] Against this background, the aim of the present study is to evaluate whether the construction of a T-graft with a segment of SV is equivalent to the construction of a T-graft with RA in terms of morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery—Comparison of the Great Saphenous Vein with the Radial Artery

Eide

Jussli-Melchers

Friedrich

et al. 2023

Thorac Cardiovasc Surg

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Background Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. Methods Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. Results A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac–cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan–Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. Conclusion CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material.

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Transit-time flowmetric evaluation of coronary artery bypass graft flow after off- and on-pump myocardial revascularization

Kornovski

Panayotov

Angelov

et al. 2018

Scripta Scientifica Medica

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Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Cited by 4 publications

References 22 publications

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting

Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery—Comparison of the Great Saphenous Vein with the Radial Artery

Transit-time flowmetric evaluation of coronary artery bypass graft flow after off- and on-pump myocardial revascularization

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