Conduits’ Biology Regulates the Outcomes of Coronary Artery Bypass Grafting

Gharibeh, Lara; Ferrari, Giovanni; Ouimet, Mireille; Grau, Juan B.

doi:10.1016/j.jacbts.2020.11.015

Cited by 19 publications

(37 citation statements)

References 48 publications

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“…The morphology as well as cellular and biochemical composition of the conduits affect the development of atherosclerosis. 25 Some reports have indicated that other causes of occlusion were epithelial injuries, thrombosis, intimal thickening, and atherosclerosis progression caused by spasm due to intraoperative manipulation, distension under arterial pressure, or loss of the vasa vasorum. 14,[26][27][28][29] Nevertheless, SVGs are widely used as bypass conduits for CABG as they have several advantages.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel

Sakurai

Someya

Yamamoto

et al. 2022

Innovations�(Phila)

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Objective Saphenous vein grafts (SVGs) are widely used as bypass conduits in coronary artery bypass grafting. Compared with the conventional technique, the “no-touch” technique, wherein the saphenous veins are harvested with the surrounding tissue, may improve SVG patency; however, there are concerns regarding wound complications. To address this issue, we describe our novel no-touch technique with separate skin incisions using a long-shafted ultrasonic scalpel and report the clinical outcomes. Methods We enrolled 66 male patients who underwent isolated coronary artery bypass grafting between April 2016 and April 2021. There were 30 and 36 patients treated using our no-touch technique and the conventional technique, respectively. The participants underwent coronary angiography before discharge and were followed clinically. SVG samples were taken for pathological examination. Results SVGs harvested using our no-touch technique displayed preservation of the vessel wall structure and surrounding tissues. Our no-touch technique demonstrated no inferiority in patency compared with the conventional technique, and there was no SVG occlusion in the no-touch group. The frequency of leg wound complications was higher in the no-touch group than the conventional group, but no surgical site infections and severe complications occurred in the no-touch group. Conclusions SVGs harvested using our novel no-touch technique had similar pathological characteristics to those harvested using the original no-touch technique reported previously. Our no-touch technique maintained SVG patency and caused no severe wound complications. However, a large-scale, longitudinal study is required to accurately assess the clinical outcomes of our no-touch technique.

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Section: Discussionmentioning

confidence: 99%

Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel

Sakurai

Someya

Yamamoto

et al. 2022

Innovations�(Phila)

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show abstract

“…Coronary artery bypass grafting (CABG) remains the gold standard treatment for complex multi-vessel coronary artery disease, particularly triple vessel or left main disease. 1,2 To achieve coronary revascularisation, venous and arterial conduits are used. Advantages of utilizing the left internal mammary artery (LIMA) over a vein graft in coronary revascularisation are well established.…”

Section: Introductionmentioning

confidence: 99%

“…Advantages of utilizing the left internal mammary artery (LIMA) over a vein graft in coronary revascularisation are well established. [2][3][4][5] The LIMA has become the most frequently used conduit in coronary artery bypass surgery due to its superior long-term patency rates and significantly improved survival of patients. [2][3][4][5][6] Long-term survival after CABG is attributed to the LIMA to left anterior descending (LAD) coronary artery anastomosis, given the large myocardial territory this vessel supplies.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] The LIMA has become the most frequently used conduit in coronary artery bypass surgery due to its superior long-term patency rates and significantly improved survival of patients. [2][3][4][5][6] Long-term survival after CABG is attributed to the LIMA to left anterior descending (LAD) coronary artery anastomosis, given the large myocardial territory this vessel supplies. [2][3][4] Additionally, LIMA to LAD anastomoses have been shown to have >95% patency rates at 20 years post CABG, due to reduced incidence of graft atherosclerosis, 2 whereas accelerated atherosclerosis is common when vein grafts, such as the saphenous vein, are utilized in coronary revascularisation.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5][6] Long-term survival after CABG is attributed to the LIMA to left anterior descending (LAD) coronary artery anastomosis, given the large myocardial territory this vessel supplies. [2][3][4] Additionally, LIMA to LAD anastomoses have been shown to have >95% patency rates at 20 years post CABG, due to reduced incidence of graft atherosclerosis, 2 whereas accelerated atherosclerosis is common when vein grafts, such as the saphenous vein, are utilized in coronary revascularisation. 2,5 Advantages of the LIMA over other conduits can be attributed to its functional and structural similarity to coronary arteries in terms of wall thickness and lumen diameter, and to biological properties including the presence of a complete internal elastic lamina.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of the internal mammary artery size in Aboriginal and Torres Strait islanders

Knox

Gimpel

Lance

et al. 2022

ANZ Journal of Surgery

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Background: Variation in size of the internal mammary artery has been demonstrated in ethnic groups, but not reported in Aboriginal patients. We hypothesised that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients and aimed to determine the impact on survival following coronary artery bypass graft (CABG) surgery. Methods: Left internal mammary artery size was compared between Aboriginal (n = 345) and non-Aboriginal (n = 1819) in 2343 patients undergoing CABG at Flinders Medical Centre from January 2010 to June 2021. To determine the association with-survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables.Results: There was a significant difference in left internal mammary artery (LIMA) size-Aboriginal 1.8 AE 0.4 mm; non-Aboriginal 2.1 AE 0.4 mm (P < 0.001)-and left anterior descending (LAD) artery size-Aboriginal 1.7 AE 0.3 mm; non-Aboriginal 1.9 AE 0.3 mm (P < 0.001). Aboriginal patients were more likely to have the LIMA discarded (9.3% vs. 0.4%) and to receive a LAD vein graft (17% versus 3%) (P < 0.001). There was no difference in 30-day mortality or survival <5 years. Conclusion: This study supports the hypothesis that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients. Although Aboriginal patients were more likely to receive a venous conduit to the LAD, we observed no difference in survival up to 5 years. This data contrasts with reported outcomes of other ethnic groups.

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Surgical Management of Coronary Artery Disease

Powell,

Watts

2023

Cardiovascular Manual for the Advanced Practice Provider

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Conduits’ Biology Regulates the Outcomes of Coronary Artery Bypass Grafting

Cited by 19 publications

References 48 publications

Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel

Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel

Quantification of the internal mammary artery size in Aboriginal and Torres Strait islanders

Surgical Management of Coronary Artery Disease

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