Patency of conduits in patients who received internal mammary artery, radial artery and saphenous vein grafts

Abstract

Background Where each patient has all three conduits of internal mammary artery (IMA), saphenous vein graft (SVG) and radial artery (RA), most confounders affecting comparison between conduits can be mitigated. Additionally, since SVG progressively fails over time, restricting patient angiography to the late period only can mitigate against early SVG patency that may have occluded in the late period. Methods Research protocol driven conventional angiography was performed for patients with at least one of each conduit of IMA, RA and SVG and a minimum of 7 years postoperative. The primary analysis was perfect patency and secondary analysis was overall patency including angiographic evidence of conduit lumen irregularity from conduit atheroma. Multivariable generalized linear mixed model (GLMM) was used. Patency excluded occluded or “string sign” conduits. Perfect patency was present in patent grafts if there was no lumen irregularity. Results Fifty patients underwent coronary angiography at overall duration postoperative 13.1 ± 2.9, and age 74.3 ± 7.0 years. Of 196 anastomoses, IMA 62, RA 77 and SVG 57. Most IMA were to the left anterior descending territory and most RA and SVG were to the circumflex and right coronary territories. Perfect patency RA 92.2% was not different to IMA 96.8%, P = 0.309; and both were significantly better than SVG 17.5%, P < 0.001. Patency RA 93.5% was also not different to IMA 96.8%, P = 0.169, and both arterial conduits were significantly higher than SVG 82.5%, P = 0.029. Grafting according to coronary territory was not significant for perfect patency, P = 0.997 and patency P = 0.289. Coronary stenosis predicted perfect patency for RA only, P = 0.030 and for patency, RA, P = 0.007, and SVG, P = 0.032. When both arterial conduits were combined, perfect patency, P < 0.001, and patency, P = 0.017, were superior to SVG. Conclusions All but one patent internal mammary artery or radial artery grafts had perfect patency and had superior perfect patency and overall patency compared to saphenous vein grafts.

Aortic Coarctation Effect on Atherosclerosis of the Left Internal Mammary Artery: A Case Presentation and Literature Review

“…The use of the IMA graft has been an essential advance in myocardial surgical revascularization. Long-term patency rates of this and other arterial conduits are higher than those with saphenous vein grafts, especially when used for the LAD [ 3 ].…”

“…Chen et al in 1995 [ 3 ] reported two patients, 61 and 71 years old, who had atherosclerosis of both the left and right IMAs at the time of surgical revascularization. The IMAs were heavily calcified in both patients and were not suitable for grafting.…”

Redo MIDCAB in a Septuagenarian in our Setting, Fantasy or Fact? - A Case Report

“…Patent grafts isolation is essential for a successful redo CABG 10 , as it can contravene the protective effects of cardioplegia by maintaining a continuous flow of normal warm blood with low pottasiun. Moreover, in redo coronary surgery where previous venous graft is present, intraoperative myocardial infarction may occur due to thrombus dislodgment during manipulation of venous grafts 11 .…”

Early cardiac contractility outcome of reoperative coronary artery bypass grafting using right gastroepiploic artery

“…Injury to an ITA graft has been associated with a mortality rate of 17.9% 14 . Another risk associated with resternotomy where previous grafts are present is intraoperative myocardial infarction because of thrombus dislodgment during manipulation of venous grafts, which carry a higher risk of thrombosis compared with arterial grafts 15 . If the patent ITA and the venous graft have adhered to the back of the sternum, an anterolateral thoracotomy may be helpful to dissect the heart in patients who need revascularization 16 .…”