A novel composite coronary bypass graft strategy: the saphenous vein bridge—a pilot study

Tremblay, Jean François; Stevens, Louis–Mathieu; Chartrand-Lefèbvre, Carl; Chandonnet, Martin; Mansour, Samer; Soulez, Gilles; Priéto, Ignacio; Basile, Fadi; Noiseux, Nicolas

doi:10.1093/ejcts/ezt388

Cited by 9 publications

(9 citation statements)

References 25 publications

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“…Based on our experience [10], 2.15 grafts on average are required on the anterolateral territory (that is, for about 15% of patients >2 grafts will be performed on the anterolateral territory). We can estimate the graft patency index for all anterolateral grafts in the conventional group with separate LIMA-LAD and SVG to anterolateral coronary targets at ((96% + (1.15 x 85%))/2.15) = 90%.…”

Section: Methodsmentioning

confidence: 99%

“…In a pilot study with 256 patients (mean follow-up of 3 years), we demonstrated the feasibility and security of the new CABG technique [10]. Incidences of clinical events (mortality, myocardial infarction (MI), low cardiac output syndrome, re-exploration for bleeding and recurrence of angina) over the short and long term were low.…”

Section: Introductionmentioning

confidence: 99%

“…Incidences of clinical events (mortality, myocardial infarction (MI), low cardiac output syndrome, re-exploration for bleeding and recurrence of angina) over the short and long term were low. The graft patency of 20 patients operated according to the LSVB strategy was assessed in a sub-study using 256-slice computed tomography (MSCT) angiography after a mean follow-up of 51 months [10]. The 256-slice MSCT angiography is a non-invasive imaging technique that allows comprehensive and objective assessment of grafts and coronary arteries with an elevated diagnostic accuracy [11-14].…”

Section: Introductionmentioning

confidence: 99%

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Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

Drouin¹,

Noiseux

Chartrand-Lefèbvre

et al. 2013

Trials

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BackgroundIn severe coronary artery disease, coronary artery bypass grafting (CABG) surgery is indicated to re-establish an adequate blood supply to the ischemic myocardium. Effectiveness of CABG surgery for symptom relief and mortality decrease should therefore depend on bypass graft patency. As bypass using a left internal mammary artery (LIMA)-to-left anterior descending coronary artery (LAD) anastomosis allows the best results in terms of graft patency, we designed a new surgical technique using a saphenous vein graft as a venous bridge to distribute the LIMA flow to the cardiac anterolateral territory. This novel strategy could extend the patency benefits associated to the LIMA. Other potential benefits of this technique include easier surgical technique, possibility to use saphenous vein grafts as vein patch angioplasty, shorter saphenous vein grafts requirement and reduced or eliminated manipulations of the ascendant aorta (and associated stroke risk).Methods/DesignBetween July 2012 and 2016, 200 patients undergoing a primary isolated CABG surgery using cardiopulmonary bypass with a LAD bypass graft and at least another target on the anterolateral territory will be randomized (1:1) according to 1) the new composite strategy and 2) the conventional strategy with a LIMA-to-LAD anastomosis and revascularization of the other anterolateral target(s) with a separated aorto-coronary saphenous vein graft. The primary objective of the trial is to assess whether the composite strategy allows non-inferior anterolateral graft patency index (proportion of non-occluded CABGs out of the total number of CABGs) compared to the conventional technique. The primary outcome is the anterolateral graft patency index, evaluated at one year by 256-slice computed tomography angiography. Ten years of clinical follow-up is planned to assess clinical outcomes including death, myocardial infarction and need for revascularization.DiscussionThis non-inferiority trial has the potential to advance the adult cardiac surgery field, given the potential benefits associated with the composite grafting strategy.Trial registrationClinicalTrials.gov: NCT01585285.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

Drouin¹,

Noiseux

Chartrand-Lefèbvre

et al. 2013

Trials

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“…These patients (n=40) were prospectively selected to undergo CT angiography in the context of two other studies (11,12).…”

Section: Study Populationmentioning

confidence: 99%

“…The LIMA is grafted on the hood of the SVB, usually immediately above the LAD anastomosis, to ensure an "almost" direct LIMA-LAD anastomosis, while also providing flow to the other arteries of the anterolateral territory through the SVB ( Figure 2). Clinical follow-up showed this technique to be feasible and safe (10). Preliminary results of conventional or CT angiographic follow-up have shown that, when present, graft dysfunction (stenosis or occlusion) of the composite LIMA-SVB graft is usually limited to the A C C E P T E D M A N U S C R I P T…”

Section: Introductionmentioning

confidence: 99%

A morphometric 3D model of coronary artery bypass graft dysfunction with multidetector computed tomography

et al. 2015

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Coronary artery bypass graft imaging with 256-slice MDCT: surgical concepts, current techniques, and interpretation

Rau¹,

Rau²,

Chin³

et al. 2014

Clinical Imaging

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A novel composite coronary bypass graft strategy: the saphenous vein bridge—a pilot study

Abstract: Revascularization of the anterolateral territory using the LIMA-SVB is a promising approach considering its clinical safety and favourable patency rate results. A prospective randomized clinical trial is underway to compare this technique to conventional CABG.

Cited by 9 publications

References 25 publications

Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

Composite versus conventional coronary artery bypass grafting strategy for the anterolateral territory: study protocol for a randomized controlled trial

A morphometric 3D model of coronary artery bypass graft dysfunction with multidetector computed tomography

Coronary artery bypass graft imaging with 256-slice MDCT: surgical concepts, current techniques, and interpretation

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