Plication of the right atrium in order to confront a right coronary artery under tension graft

Abstract

An under tension graft to the right coronary artery may result in graft spasm, hypoperfusion and myocardial infarction. We suggest plication of the right atrium in order to confront the under tension graft (either arterial or venous), if tension is due to a shorter (up to 2 cm) graft than one needed. We present this technique applied to 10 of our patients. The radial artery was the under tension graft in two cases and a saphenous vein in eight. Perioperative and postoperative arrhythmias, myocardial infarction, hemorrhage and jugular or hepatic congestion were not observed. Central vein pressure remained normal. Tricuspid valve--estimated by postoperative echo--was undisturbed. Plication of the right atrium in case of an under tension graft is a quick, simple and safe technique.

Long-term graft patency after coronary artery bypass grafting. Effects of morphological and pathophysiological factors

“…Compared with graft type, graft length-related patency was not analyzed by extensive studies. According to small series ( 18 ) and case presentations ( 19 ), a short, tensed graft is predisposed to spasm in the case of arteries and to flattening in the case of veins with hypoperfusion of the grafted territory compared with a long graft with excessive length that is predisposed to transection and kinking. Graft length could prove insufficient secondary to imprecise estimation of the cardiac volume or of the graft itself, peripheral localization of the target vessel, anatomical features of the graft (high ITA bifurcation), harvesting or manipulation errors (destruction of a graft segment), and pulmonary hyperinflation (emphysema).…”

“…Graft length could prove insufficient secondary to imprecise estimation of the cardiac volume or of the graft itself, peripheral localization of the target vessel, anatomical features of the graft (high ITA bifurcation), harvesting or manipulation errors (destruction of a graft segment), and pulmonary hyperinflation (emphysema). Several techniques could be applied if a length deficit is discovered during surgery: composite anastomosis, elongation with a venous segment, using a skeletonized instead of a pedicled graft, right atrial plication ( 18 ), and grafting the CX territory via the transverse sinus ( Fig. 3 ).…”