Morphologic changes of the saphenous vein Y-composite graft based on the left internal thoracic artery: 1-year intravascular ultrasound study

Hwang, Ho Young; Koo, Bon Kwon; Oh, Se Jin; Kim, Ki Bong

doi:10.1016/j.jtcvs.2014.08.056

Cited by 15 publications

(10 citation statements)

References 25 publications

(32 reference statements)

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“…4 In this issue of the Journal, the same group has published an observational study to provide potential mechanistic reasons for the trial findings. 5 More specifically, Hwang and colleagues 5 have published their single-institution cohort of 28 patients who underwent off-pump coronary artery bypass grafting surgery (CABG) with the no-touch SVG harvesting technique; as in the trial, these were constructed as composite Y-grafts from the in situ LITA. They performed quantitative angiography immediately after CABG and at 1 year; intravascular ultrasonography was only performed at 1 year for ethical reasons.…”

mentioning

confidence: 99%

Composite vein grafting: Is it a “Y's” decision?

Deb

Souza²,

Fremes

2015

The Journal of Thoracic and Cardiovascular Surgery

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mentioning

confidence: 99%

Composite vein grafting: Is it a “Y's” decision?

Deb

Souza²,

Fremes

2015

The Journal of Thoracic and Cardiovascular Surgery

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“…Despite lower GSV patency in the long term, we believe that it can provide better results when used as secondary conduit in LITA composite grafts, due to the following factors: grafts using small GSV segments without valves, which are predisposed sites for the development of atherosclerotic disease and which can provide a state of hemodynamic stasis and thrombosis [24] ; GSV anastomosed to the LITA might present less circulatory stress and flow turbulence than when compared to GSV directly anastomosed to the aorta, possibly minimizing the development of venous graft disease [25] ; in addition to this, it is possible that part of the endothelium protective factors, produced by LITA, may act in benefit of GSV segments [24,25] .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Filho¹,

Filho²,

Pimentel³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveComposite graft of left internal thoracic artery and great saphenous vein in revascularization of the left coronary system is a technique well described in literature. The aim of this study is to analyze blood flow dynamics in this configuration of composite graft especially in what concerns left internal thoracic artery's adaptability and influence of great saphenous vein segment on left internal thoracic artery's flow.MethodsRevascularization of left coronary system with composite graft, with left internal thoracic artery revascularizing the anterior interventricular artery and a great saphenous vein segment, anastomosed to the left internal thoracic artery, revascularizing another branch of the left coronary system, was performed in 23 patients. Blood flow was evaluated by transit time flowmetry in all segments of the composite graft (left internal thoracic artery proximal segment, left internal thoracic artery distal segment and great saphenous vein segment). Measures were performed in baseline condition and after dobutamine-induced stress, without and with non-traumatic temporary clamping of the distal segments of the composite graft.ResultsPharmacological stress resulted in increase of blood flow values in the analyzed segments (P<0.05). Non-traumatic temporary clamping of great saphenous vein segment did not result in statistically significant changes in the flow of left internal thoracic artery distal segment, both in baseline condition and under pharmacological stress. Similarly, non-traumatic temporary clamping of left internal thoracic artery distal segment did not result in statistically significant changes in great saphenous vein segment flow.ConclusionComposite grafts with left internal thoracic artery and great saphenous vein for revascularization of left coronary system, resulted in blood flow dynamics with physiological adaptability, both at rest and after pharmacological stress, according to demand. Presence of great saphenous vein segment did not alter physiological blood flow dynamics in distal segment of left internal thoracic artery.

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“…The reversed SV was then anastomosed to the in situ left ITA to construct a composite graft, continuously exposing the SV to endothelium‐protective substances, such as NO released from the left ITA 5,15 . In addition, it has been suggested that the NT SV composite grafts based on the ITA go through a process of advantageous negative remodeling because the SV showed decreased lumen diameter but a similar ratio of intima‐media thickness to that of the left ITA during the first postoperative year 18 . In the present study, the occlusion rates were lower and reopening rates of occluded SV conduits were higher in patients who received the NT SV with pedicle tissue than in patients who received the NT SV without pedicle tissue, although the statistical significance was marginal.…”

Section: Commentmentioning

confidence: 99%

Reopening of the occluded saphenous vein composite grafts after coronary artery bypass grafting

Kim

2021

Journal of Cardiac Surgery

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Background We have observed reopening of the occluded “no‐touch” saphenous vein (NT SV) composite grafts on follow‐up angiograms in patients who underwent coronary artery bypass graftings (CABGs). Methods Between 2008 and 2018, 1283 patients received NT SV conduits without or with surrounding pedicle tissue as composite grafts based on the in situ left internal thoracic artery (ITA) for CABG and underwent early postoperative angiographies. Among the 1283 patients, 53 patients showed 55 occluded SV conduit anastomoses, and 46 patients who had 48 occluded SV anastomoses were re‐evaluated by 1‐year postoperative angiographies. Results Early postoperative angiographies in 1283 patients demonstrated overall occlusion rates of 1.2% (56/4518); occlusion rates of the ITA and SV were 0.08% (1/1259) and 1.7% (55/3260), respectively. One‐year angiograms demonstrated that 14 occluded SV anastomoses (29.2% [14/48 occluded SV]) of 14 patients became patent. Reopening of occluded SV conduits occurred more frequently in NT SV with pedicle tissue than in NT SV without pedicle tissue (45.0% [9/20] vs. 17.9% [5/28]; p = .057). When we examined the preoperative and 1‐year postoperative angiograms, reopening of the occluded SV conduits was not related with progression (p = .258) or preoperative reversibility score (p = .115) of native target coronary artery disease. Conclusions More than a quarter of the occluded SV composite grafts on early postoperative angiograms were patent in the 1‐year angiograms. The reopening rates were higher in patients who had received NT SV conduits with pedicle tissue than those who had received NT SV conduits without pedicle tissue.

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Morphologic changes of the saphenous vein Y-composite graft based on the left internal thoracic artery: 1-year intravascular ultrasound study

Abstract: Saphenous vein conduits harvested with minimal manipulation and used as Y-composite grafts based on the left ITA revealed decreased LD without accompanying abnormal IM thickening based on the flow requirements at 1 year postoperatively.

Cited by 15 publications

References 25 publications

Composite vein grafting: Is it a “Y's” decision?

Composite vein grafting: Is it a “Y's” decision?

Intraoperative analysis of flow dynamics in arteriovenous composite Y grafts

Reopening of the occluded saphenous vein composite grafts after coronary artery bypass grafting

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