Aortocoronary Bypass Grafting With Multiple Sequential Anastomoses to a Single Vein

Bartley, Thomas D.; Bigelow, John; Page, U. Scott

doi:10.1001/archsurg.1972.04180120092017

Cited by 59 publications

(14 citation statements)

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“…The sequential coronary artery bypass grafting (CABG) technique, as described in early years [1,2], is a technique in which two or more coronary artery anastomoses are made with a single graft, usually the saphenous vein. The distal anastomosis is constructed in an end-to-side fashion, while the proximal anastomosis is constructed in a side-to-side fashion.…”

Section: Introductionmentioning

confidence: 99%

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Sankaranarayanan

Ghista

Chua

et al. 2009

Computational Cardiovascular Mechanics

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Coronary artery bypass graft (CABG) is a major therapy for ischemic heart disease which if left untreated can progress to failure of the heart. Restenosis, a leading cause of CABG, can be correlated with the geometric configuration and the hemodynamics of the graft. In this chapter we use computational fluid dynamics (CFD) to investigate the hemodynamics in a 3D out-of-plane sequential bypass graft model. Using a finite volume approach, quasi-steady flow simulations are performed at mid-ejection and at mid-diastole. Plots of velocity vectors, wall shear stress (WSS), and spatial WSS gradient (WSSG) distribution are presented in the aorto-left coronary bypass graft domain. Simulation results reveal a more uniform WSS and spatial WSSG distribution in the side-to-side (sequential graft) anastomosis configuration over the end-to-side (multiple graft) anastomosis. Results for the multiple bypass graft model show the peak magnitudes of the spatial WSSG are higher compared to the sequential bypass graft model. These findings suggest that sequential bypass grafting may be preferable over multiple bypass grafting to avoid non-uniformities of WSS. IntroductionThe sequential coronary artery bypass grafting (CABG) technique, as described in early years [1,2], is a technique in which two or more coronary artery anastomoses are made with a single graft, usually the saphenous vein. The distal anastomosis is constructed in an end-to-side fashion, while the proximal anastomosis is constructed in a side-to-side fashion. The advantages of this technique over the single graft technique include fewer anastomoses and higher graft flow [3,4]. Higher patency rates have also been observed through post angiograms in the proximal side-to-side M. Sankaranarayanan (B) Mathematics,

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Section: Introductionmentioning

confidence: 99%

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Sankaranarayanan

Ghista

Chua

et al. 2009

Computational Cardiovascular Mechanics

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“…Composite grafts have been studied since the early 1970s,1 and have promised several advantages. These include the option of avoiding aortic manipulation entirely with off-pump total arterial revascularisation, shorter procedure times, a potentially better run off when the distal vascular bed is diseased or supplying only partially viable myocardium, and in situations where saphenous veins are limited and of poor quality.…”

Section: Discussionmentioning

confidence: 99%

Coronary steal or large collateral? Three cases of graft failure in sequential and composite grafts

et al. 2014

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Coronary bypass grafting using conduits with multiple distal anastomoses continues to demand scrutiny. While on one hand these techniques allow the surgeon to avoid or minimise aortic manipulation, the unique flow and pressure characteristics lead to complex forms of graft failure if the anatomy of the target vascular bed is not carefully taken into consideration. We report three cases of graft failure in patients with coronary bypass grafting performed using multiple distal anastomoses, and percutaneous revascularisation in one patient.

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“…As noted above, m-SVGs offer several advantages, including conservation of graft material, shorter time for revascularization, more complete revascularization, and hemodynamic advantages that include higher flow velocity in the proximal segment. 19 More than 3 decades after its introduction, 1,2 controversy plagues the use of m-SVG conduits with studies providing contradictory information about long-term patency and outcomes. 1–8,11–16 Much has been written about theoretical advantages of various refinements in the use of m-SVG (eg, Y grafts versus sequential grafts, side-to-side anastomosis to a small branch or poor-quality native artery, and end-to-side anastomosis to larger major epicardial or good-quality vessel), but none of these refinements have been uniformly tested in large numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

Saphenous Vein Grafts With Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery

et al. 2011

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Background Limited information exists on the intermediate-term graft patency and 5-year clinical outcomes of patients receiving saphenous vein grafts with multiple (m-SVG) versus single distal targets (s-SVG) during coronary artery bypass graft (CABG) surgery in the current era. Methods and Results We studied the association of the use of m-SVG versus s-SVG conduits with 1-year SVG failure (defined as ≥75% angiographic stenosis) and 5-year clinical events (death; death or myocardial infarction [MI]; and death, MI, or revascularization) in 3014 patients undergoing their first CABG surgery enrolled in the Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV. Of 3014 patients enrolled in PREVENT IV, 1045 (34.7%) had ≥1 m-SVGs during CABG. Vein graft failure at 1-year was higher for m-SVG compared with s-SVG (adjusted odds ratio 1.24, 95% confidence interval 1.03 to 1.48). At 5 years, the adjusted composite of death, MI (including perioperative MI), or revascularization (hazard ratio 1.15, 95% confidence interval 1.00 to 1.31) and death or MI (hazard ratio 1.21, 95% confidence interval 1.03 to 1.43) were significantly higher in patients receiving m-SVGs. Conclusions In patients undergoing first CABG surgery, the use of m-SVG was associated with a higher 1-year vein graft failure rate and trends toward worse clinical outcomes. Additional studies are needed to better understand the most appropriate conduit to improve long-term graft patency and clinical outcomes of patients undergoing CABG surgery. In the meantime, these data should encourage the use of s-SVG over m-SVG when feasible.

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Aortocoronary Bypass Grafting With Multiple Sequential Anastomoses to a Single Vein

Cited by 59 publications

References 0 publications

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Coronary steal or large collateral? Three cases of graft failure in sequential and composite grafts

Saphenous Vein Grafts With Multiple Versus Single Distal Targets in Patients Undergoing Coronary Artery Bypass Surgery

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