Long-term patency of sequential and individual saphenous vein coronary bypass grafts

Vural, Kerem M.; Şener, Erol; Taşdemi̇r, Oğuz

doi:10.1016/s1010-7940(00)00629-1

Cited by 74 publications

(77 citation statements)

References 12 publications

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“…In comparison to the previous bypass with individual graft, the double bypass demonstrates higher blood flow and velocity in the proximal (pre-anastomotic) segment of the sequential graft. This observation is in accordance with intraoperative studies, e.g., [14], which imply higher patency rates for the bypasses with side-to-side anastomoses. The influence of the out-of-plane geometry on the shape of the velocity profiles is well apparent in the case of the side-to-side anastomosis, Fig.…”

Section: Double Bypasssupporting

confidence: 91%

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Modelling of Blood’s Non-Newtonian Behaviour in Patient-Specific Aorto-Coronary Bypass Grafts

Vimmr¹,

Jonášová²,

Bublík³

2014

Proceedings of 10th World Congress on Computational Mechanics

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Abstract. The patency and overall performance of implanted bypass grafts is closely related to hemodynamics and its influence on vessel remodelling. In this regard, numerical investigation of blood flow in models reconstructed from clinical data may, next to clinical research, provide a valuable insight into the problem of graft failures, which are usually associated with restenosis and/or occlusive intimal hyperplasia. In this study, numerical results of pulsatile non-Newtonian blood flow in three realistic aorto-coronary bypass models are presented and further discussed with emphasis placed on the distribution of wall shear stress (WSS) and oscillatory shear index (OSI). Blood's shear-thinning behaviour is described by the CarreauYasuda model. Assuming all model walls to be impermeable and inelastic, the numerical solution of the mathematical model, which has the form of time-dependent non-linear system of Navier-Stokes (NS) equations, is carried out on the basis of the three-stage fractional step method and cell-centred finite volume method formulated for hybrid unstructured tetrahedral grids. The viscous terms of the NS equations are time discretised implicitly using the CrankNicolson scheme. The convective terms are solved explicitly and their computation utilises a local time-stepping technique in order to improve the overall computational efficiency of the developed CFD code.

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Section: Double Bypasssupporting

confidence: 91%

“…Beside thrombogenesis, usually originating in low flow rates or technical mistakes, [14], the majority of recorded bypass failures is often caused by intimal hyperplasia, [6]. This type of intimal thickening represents a form of abnormal healing process observed at several sites of the distal anastomosis, Fig.…”

Section: Introductionmentioning

confidence: 99%

Modelling of Blood’s Non-Newtonian Behaviour in Patient-Specific Aorto-Coronary Bypass Grafts

Vimmr¹,

Jonášová²,

Bublík³

2014

Proceedings of 10th World Congress on Computational Mechanics

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“…Increased graft flow rate has been associated with decreased SVG intimal proliferation (15). Some series have reported better TTF measurements (16,17) or patency (15,18) results with sequential grafting strategy compared to single graft while others have not (19)(20)(21). A meta-analysis of 12 studies comparing the patency of sequential and individual vein grafts concluded that the mid-and long-term patency of sequential vein grafts were superior to single vein grafts (14).…”

Section: Coronary Graft Flow Measurementmentioning

confidence: 99%

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

et al. 2014

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Objectives Intraoperative assessment of coronary artery bypass grafts (CABG) anastomotic quality can be performed using transit-time flowmetry (TTF). The aim of this study was to compare on- versus off-pump coronary graft TTF and early postoperative outcomes. Materials and methods Between January 2009 and January 2010, 521 distal graft flows were assessed using TTF measurements in 253 consecutive patients undergoing primary isolated CABG surgery. Data were analyzed using multilevel models accounting for clustering among surgeons and grafts performed in the same patient. Results Mean age was 66 ± 10 years and 22% were female (n = 55) with 34% diabetics (n = 86) and 40% pre-operative myocardial infarction (MI) (n = 101). The surgeries were performed off-pump in 67% (n = 170) with sequential vein grafts in 57% (n = 144) of patients. Off-pump patients had higher pre-operative left ventricular ejection fractions (LVEF), fewer urgent surgeries, fewer distal anastomoses, and fewer sequential vein grafts (all p<0.001). Intra-operative coronary graft TTF measurements were lower in sequential vein grafts performed off-pump versus on-pump. More patients in the on-pump group needed milrinone or dobutamine 24-48 h postoperatively (p = 0.005). Independent predictors of lower TTF included female gender and off-pump surgery, whereas predictors of better TTF were pre-operative MI, larger coronary diameter at the site of the distal anastomosis, and sequential vein grafting. Conclusions Lower intra-operative TTF measurements were found in sequential vein grafts in offpump CABG. However, off-pump patients experienced similar short-term outcomes compared to on-pump patients.

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“…Intimal hyperplasia is highly associated with local homodynamic adverse factors such as large wall shear stress gradients and high disturbed flow [1,2]. Moreover, there is a higher degree of compliance mismatch between the coronary artery and SVG, which might cause elevated intramural stress of the suture line, resulting in intramural hyperplasia [2].…”

Section: Commentmentioning

confidence: 99%

Coronary Artery Bypass Grafting Using Side-to-Side Anastomosis with Distal End Clipping of the Saphenous Vein Graft

Matsuyama¹,

Kurabayashi²,

Koizumi³

et al. 2014

J Vasc Med Surg

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Although the Saphenous Vein Graft (SVG) is commonly grafted to the coronary artery with an end-to-side anastomotic technique, there is often a significant mismatch between the diameters of the SVG and the coronary artery, which may cause SVG failure. To overcome such a drawback of the standard end-to-side SVG anastomosis, we introduce a novel side-to-side anastomosis with distal end clipping of the SVG in coronary artery bypass grafting.The long-term outcome of Coronary Artery Bypass Grafting (CABG) depends predominantly on graft patency. Although an arterial graft is preferably used to improve long-term graft patency, a Saphenous Vein Graft (SVG) is also still widely used as a second bypass graft. The reported SVG patency ranging from 25% to >50% within 10 years was inferior to that of an arterial graft, despite considerable efforts to prevent SVG failure. Although the SVG is commonly grafted to the coronary artery with an end-to-side anastomotic technique, there is often a significant mismatch between the diameters of the SVG and the coronary artery, which may cause SVG failure. Moreover, the end-to-side anastomotic configuration has been reported to have an adverse effect on local hemodynamics, resulting in intimal hyperplasia in the long-term. The intimal hyperplasia, which is a major cause of late graft failure, has been shown to occur predominantly at the toe, heel, and bed of the host coronary artery around the distal anastomosis. TechniqueCABG is performed routinely with an off-pump technique in our unit. Initially, the skeletonized left internal mammary artery is grafted to the left anterior descending artery in a fundamental fashion. When the right internal mammary artery is used, it is grafted to the circumflex system through the transverse sinus. The gastroepiploic artery or the radial artery is rarely used. The SVG is used for the remaining coronary vessels such as the right coronary artery, the circumflex artery, and the diagonal branch. Sequential anastomoses with the SVG are performed in a diamond-shape or parallel fashion using a 7-0 polypropylene continuous suture, depending on coronary anatomy. The most distal side-to-side anastomosis is usually performed in a parallel fashion with a 7-0 polypropylene continuous suture (Figure 1). The distal end of the SVG is closed with surgical clips as close to the anastomosis as possible, paying attention not to cause any deformity at the anastomotic site (Figure 2). The SVG is then fixed to the epicardium at the heel of the anastomosis to avoid kinking. The proximal anastomosis is constructed on the ascending aorta with a 6-0 polypropylene continuous suture using a suture device. Figure 1: The distal end of the SVG is grafted to the coronary artery in a parallel end-to-end fashion with a 7-0 polypropylene continuous suture.

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Long-term patency of sequential and individual saphenous vein coronary bypass grafts

Cited by 74 publications

References 12 publications

Modelling of Blood’s Non-Newtonian Behaviour in Patient-Specific Aorto-Coronary Bypass Grafts

Modelling of Blood’s Non-Newtonian Behaviour in Patient-Specific Aorto-Coronary Bypass Grafts

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

Coronary Artery Bypass Grafting Using Side-to-Side Anastomosis with Distal End Clipping of the Saphenous Vein Graft

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