Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: A prospective randomized clinical, functional, and angiographic midterm evaluation

Glineur, David; Hanet, Claude; Poncelet, Alain; D’Hoore, William; Funken, Jean-Christophe; Rubay, Jean; Astarci, Parla; Lacroix, Valérie; Verhelst, Robert; Etienne, Pierre Yves; Noirhomme, Philippe; Khoury, Gébrine El

doi:10.1016/j.jtcvs.2008.01.016

Cited by 30 publications

(20 citation statements)

References 23 publications

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“…Regarding conduit choice, our results confirmed that SVG was more reliable than arterial grafts when MLD is larger than the cut-off value for arterial grafts and lower than that for SVG. This finding is consistent with the conduit choice for RCA reported by Glineur and colleagues [ 19 ]. If MLD is larger than the cut-off value for SVG, deferral of grafting or stent implantation can be considered.…”

Section: Discussionsupporting

confidence: 92%

Predictors and prevention of flow insufficiency due to limited flow demand

Nakajima

Iguchi

Tabata

et al. 2014

J Cardiothorac Surg

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BackgroundWe investigated the impacts of flow demand and native coronary stenosis on graft flow and patency.MethodsWe reviewed the angiograms of 549 bypass grafts in 301 patients who underwent off-pump coronary artery bypass grafting since 2007. Grafts consisted of 237 internal thoracic artery to left anterior descending artery; 97 internal thoracic artery and 52 saphenous vein grafts to left circumflex artery; and 109 gastroepiploic artery and 54 saphenous vein grafts to right coronary artery. We selected only individual bypass grafts created as the sole bypass graft to the coronary vascular region. Flow insufficiency was defined as ≤ 20 ml/min measured intraoperatively. When a significant difference in the incidence of flow insufficiency or “not functional” occurred between higher and lower values rather than the particular minimal luminal diameter value, the highest value was defined as the cut-off minimal luminal diameter. Distal lesions were defined as stenosis at segment #4, 7, 8, 12, 13, 14, or 15.ResultsFlow insufficiency was found in 112/549 (20.4%) bypass grafts. For internal thoracic artery to left circumflex artery grafts, the cut-off minimal luminal diameter for proximal and distal lesions was 1.25 mm and 0.75 mm, respectively. For gastroepiploic artery to right coronary artery grafts, the cut-off minimal luminal diameter was 0.82 mm for proximal lesions (p = 0.005), while 10 (71%) of 14 gastroepiploic artery grafts for distal lesions presented with flow insufficiency. Univariate and multivariate analysis identified a distal lesion (odds ratio (OR): 3.12, p < 0.0001); minimal luminal diameter greater than the cut-off value (OR: 3.64, p < 0.0001); right coronary artery (OR: 18.2, p = 0.0002) and left circumflex artery (OR; 2.29, p = 0.009) grafting; and a history of myocardial infarction in the grafted region (OR: 2.21, p = 0.02) as significant predictors of flow insufficiency.ConclusionsBoth competitive flow and insufficient flow demand cause graft failure. For distal lesions, more severe stenosis is necessary to avoid graft failure, compared with proximal lesions. A revascularization strategy for distal lesions should be discussed separately from that for proximal lesions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0188-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Predictors and prevention of flow insufficiency due to limited flow demand

Nakajima

Iguchi

Tabata

et al. 2014

J Cardiothorac Surg

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“…Data from our group confirm these early observations [15]. In two prospective randomized trials [10,11 && ], we analyzed the relation between the coronary lesion evaluated by a quantitative method and the functionality of the RGEA vs SVG targeted at the posterior descending artery.…”

Section: Right Gastroepiploic Arterysupporting

confidence: 64%

“…FFR reliably identifies stenoses associated with inducible ischemia with more than 90% accuracy, a rate higher than any other noninvasive test [13][14][15][16]. Several studies have compared these three methods, demonstrating that visual assessment and QCA are of limited value for accurately predicting the significance of most intermediate narrowing and, therefore, predicting the competition phenomenon.…”

Section: Methods Of Coronary Stenosis Evaluation To Predict Flow Compmentioning

confidence: 99%

Competitive flow in coronary bypass surgery

Glineur

Hanet²

2012

Current Opinion in Cardiology

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“…Second, patency of the arterial graft to the moderately stenotic target was not favorable, 8 especially for the in situ gastroepiploic artery. 9 Saphenous vein grafts from the ascending aorta are advantageous, in terms of capacity of high intraluminal pressure and absence of critical complications associated with harvesting the graft. Jeong et al 10 have described that moderate stenosis was predictive of graft failure in arterial grafts, but not in SVG.…”

Section: Discussionmentioning

confidence: 99%

Impacts of Intraoperative Flow on Graft Patency of Sequential and Individual Saphenous Vein Grafts

et al. 2015

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Objective: We sought to delineate the predictor of saphenous vein graft (SVG) failure and to evaluate the impact of sequential grafting of SVG on graft flow as the significant predictor of patency. Methods: Angiograms and clinical records of 439 patients who underwent coronary artery bypass grafting with aortocoronary SVG were reviewed. Of these, 708 distal anastomoses were created by 480 SVGs. Of 349 patients who underwent isolated coronary artery bypass grafting, operation was performed with an off-pump technique in 347 patients (99%). For 90 patients, a combined procedure on cardiopulmonary bypass was performed. A postoperative angiography was performed in 230 SVGs for clinical reasons. Insufficient flow (IF) was defined as a graft flow of 20 mL/min or less, measured by transit-time Doppler flowmetry during operation. Results: In 480 SVGs, 44 (9.2%) presented IF, and 24 SVGs presented partial or total occlusion. Six of the nine failed individual SVG had IF, whereas none of the failed sequential SVG was associated with IF. Univariate and multivariate logistic regression analyses demonstrated that IF (P = 0.002; odds ratio, 6.63) and sequential grafting (P = 0.004; odds ratio, 2.51) were significantly correlated with a failure of the SVG. The patency rate of sequential SVG to the most distal target was 78/93 (83.9%), which was significantly lower than 9/139 (93.5%) of the individual SVG (P = 0.02) and 7/113 (93.8%) of the sequential SVG to proximal targets (P = 0.02). Conclusions: When both targets seem to have sufficient demand, avoidance of sequential grafting would be reasonable. Moreover, the important target should be grafted by individual grafting or sequential proximal anastomosis.

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Comparison of saphenous vein graft versus right gastroepiploic artery to revascularize the right coronary artery: A prospective randomized clinical, functional, and angiographic midterm evaluation

Cited by 30 publications

References 23 publications

Predictors and prevention of flow insufficiency due to limited flow demand

Predictors and prevention of flow insufficiency due to limited flow demand

Competitive flow in coronary bypass surgery

Impacts of Intraoperative Flow on Graft Patency of Sequential and Individual Saphenous Vein Grafts

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