Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery

Mohsin, Ibrahim; Namburu, Lalith; Sadiq, Zaynah; Newberry, Brian; Ahmed, Habeeb M.

doi:10.1016/j.cjco.2021.06.017

Cited by 4 publications

(3 citation statements)

References 7 publications

(17 reference statements)

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“…From what has been established about hemodynamic risk factors causing thrombosis and atherosclerosis, increased intravascular pressure, in this case arterial hypertension 5 , plays a role in graft failure directly related to flow distribution to the target vessels by decreasing total resistance to the graft flow and reducing impedance mismatch 6 . Similarly, relative stagnation of blood in the grafts caused by competitive flow between native coronary arteries and grafts, facilitates the progression of thrombosis of vein grafts 4,13 .…”

Section: Discussionmentioning

confidence: 99%

Influence of graft anastomosis and graft morphology on long-term patency of the saphenous vein after aortocoronary bypass

Okantey,

Jonszta,

Sieja

et al. 2024

BIOMED PAP

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Objective. Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting. Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. Methods. Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. Results. The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). Conclusion. Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.

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Section: Discussionmentioning

confidence: 99%

Influence of graft anastomosis and graft morphology on long-term patency of the saphenous vein after aortocoronary bypass

Okantey,

Jonszta,

Sieja

et al. 2024

BIOMED PAP

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show abstract

“…In a clinical study of 120 patients undergoing complex composite grafting procedures using BIMA, the graft patency at a mean follow-up of 29.9 ± 33.1 months for arterial grafts was between 80 and 98.7% ( 32 ). Although grafts may appear to be patent initially, those with poor flow have been found to be occluded within 1 year ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts

Chaudhuri

Pletzer

Waqanivavalagi

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesFlow competition between coronary artery bypass grafts (CABG) and native coronary arteries is a significant problem affecting arterial graft patency. The objectives of this study were to compare the predictive hemodynamic flow resulting from various total arterial grafting configurations and to evaluate whether the use of computational fluid dynamics (CFD) models capable of predicting flow can assist surgeons to make better decisions for individual patients by avoiding poorly functioning grafts.MethodsSixteen cardiac surgeons declared their preferred CABG configuration using bilateral internal mammary and radial arteries for each of 5 patients who had differing degrees of severe triple vessel coronary disease. Surgeons selected both a preferred 'aortic' strategy, with at least one graft arising from the ascending aorta, and a preferred “anaortic” strategy which could be performed as a “no-aortic touch” operation. CT coronary angiograms of the 5 patients were coupled to CFD models using a novel flow solver “COMCAB.” Twelve different CABG configurations were compared for each patient of which 4 were “aortic” and 8 were “anaortic.” Surgeons then selected their preferred grafting configurations after being shown predictive hemodynamic metrics including functional assessment of stenoses (instantaneous wave-free ratio; fractional flow reserve), transit time flowmetry graft parameters (mean graft flow; pulsatility index) and myocardial perfusion.ResultsA total of 87.5% (7/8) of “anaortic” configurations compared to 25% (1/4) of “aortic” configurations led to unsatisfactory grafts in at least 1 of the 5 patients (P = 0.038). The use of the computational models led to a significant decrease in the selection of unsatisfactory grafting configurations when surgeons employed “anaortic” (21.25% (17/80) vs. 1.25% (1/80), P < 0.001) but not “aortic” techniques (5% (4/80) vs. 0% (0/80), P = 0.64). Similarly, there was an increase in the selection of ideal configurations for “anaortic” (6.25% (5/80) vs. 28.75% (23/80), P < 0.001) but not “aortic” techniques (65% (52/80) vs. 61.25% (49/80), P = 0.74). Furthermore, surgeons who planned to use more than one unique “anaortic” configuration across all 5 patients increased (12.5% (2/16) vs. 87.5% (14/16), P<0.001).Conclusions“COMCAB” is a promising tool to improve personalized surgical planning particularly for CABG configurations involving composite or sequential grafts which are used more frequently in anaortic operations.

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“…This debate is due to the complex biophysics governing the dynamics of a particular individual’s coronary circulation and the resulting degree of uncertainty facing a surgeon. Bypass grafts that have poor flow can occlude early leading to recurrent angina and need for reintervention ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations

Chaudhuri

Pletzer²,

Smith³

2022

Front. Cardiovasc. Med.

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Cardiac surgeons face a significant degree of uncertainty when deciding upon coronary artery bypass graft configurations for patients with coronary artery disease. This leads to significant variation in preferred configuration between different surgeons for a particular patient. Additionally, for the majority of cases, there is no consensus regarding the optimal grafting strategy. This situation results in the tendency for individual surgeons to opt for a “one size fits all” approach and use the same grafting configuration for the majority of their patients neglecting the patient-specific nature of the diseased coronary circulation. Quantitative metrics to assess the adequacy of coronary bypass graft flows have recently been advocated for routine intraoperative use by cardiac surgeons. In this work, a novel patient-specific 1D-0D computational model called “COMCAB” is developed to provide the predictive haemodynamic parameters of functional graft performance that can aid surgeons to avoid configurations with grafts that have poor flow and thus poor patency. This model has significant potential for future expanded applications.

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Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery

Cited by 4 publications

References 7 publications

Influence of graft anastomosis and graft morphology on long-term patency of the saphenous vein after aortocoronary bypass

Influence of graft anastomosis and graft morphology on long-term patency of the saphenous vein after aortocoronary bypass

Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts

A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations

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