A 10-year angiographic follow-up of competitive flow in sequential and composite arterial grafts☆

Abstract

Competitive flow can be efficiently avoided by appropriate graft arrangement and patients' selection. Selection of the target of the graft end would be crucial to achieve antegrade bypass flow and long-term patency of entire sequential bypass grafts. For the composite graft, functional recovery of the occluded graft would be extremely rare.

Should all moderate coronary lesions be grafted during primary coronary bypass surgery? An analysis of progression of native vessel disease during a randomized trial of conduits

“…Faced with a moderate lesion, the surgeon might commonly choose between leaving it alone or placing a saphenous vein bypass, given that arterial grafts have been reported to show lower patency as a result of competitive flow in lesions with<70% stenosis. [4][5][6][7] The results presented here offer some contemporary data on which to base this decision, taking into account the potential impact of secondary prevention measures and the influence exerted by grafting. A number of conclusions present themselves: (1) that an ungrafted right-sided moderate lesion is less likely to progress than its left-sided counterpart, and that it has a very low hazard for progression on multivariate analysis, but that the chances of lesion progression are substantially increased if a graft is placed to this territory; and (2) that the patency of an arterial or venous graft to the moderately diseased left-sided target is relatively good at 7 to 8 years, which is possibly superior to that of right-sided grafts to similar lesions (P ¼ .051).…”

Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice?

“…11 Therefore, the CF can be efficiently avoided by appropriate graft arrangement and patients' selection. 13,14 However, the CF is a multifactorial phenomenon, and even an estimate of its impact is difficult, especially if based on preoperative coronary angiography alone. 15 Some authors recommend a few intraoperative techniques to evaluate the CF that allows us to make informed intraoperative decisions regarding anastomotic quality, vessel runoff, and competing native coronary blood flow.…”

Why and how to achieve total arterial revascularisation in coronary surgery

“…It is assumed that the patency of both limbs is primarily dependent on the integrity of the conduits and flow dynamics affecting the distal anastomoses. The influence of competitive flow has been suggested to influence composite grafts to a greater extent than aorta-coronary grafts [68][69][70] ; however, the bulk of the literature would suggest that the outcomes are similar [71][72][73][74][75][76] .…”

“…This is incorrect and exaggerated. The patency progressively diminishes as the degree of coronary stenosis decreases, and there is no specific cut-off value whereby patency falls to zero [71,[109][110][111][112] . In our as yet unpublished experience, the patency of all conduits exceeds 50% at angiography when grafted to coronary lesions of ≥ 50%.…”