Predictive factors for the intermediate-term patency of arterial grafts in aorta no-touch off-pump coronary revascularization

Abstract

For the LAD, the results of graft flow in sequential ITA grafting or composite grafting with two distal anastomoses were comparable with that in individual ITA grafting. Prediction and prevention of competitive and reverse flow are mandatory for achieving the advantages of the arterial materials.

Outcome of composite arterial Y-grafts in off-pump coronary artery bypass

“…Such grafting should be avoided in the following situations: when the target vessels are mildly stenosed; the grafts are not ITA; the RCA or LCX territories are involved; 3 or more distal anastomoses are required; end-to-side (graft end) anastomosis is required compared to side-to-side (sequential proximal anastomosis); and in 3 high-risk situations: sequential anastomoses to >2 coronary branches, each with ≤75% stenosis; to one coronary branch with ≤75% stenosis located at the distal end of the conduit and a more proximal anastomosis with >99% stenosis; and one end of the composite Y-graft anastomosed to a 75% stenosed branch of a native coronary artery and the other to a branch with >99% stenosis. 5 – 8 Our results highlight similar contraindications, especially, in cases in which one end of the composite graft is anastomosed to a 75% stenosed branch of a native coronary artery and the other end to a branch with >90% stenosis. Composite arterial grafting in OPCAB is considered effective only if we make a proper judgment on the indication for composite grafting.…”

Off-Pump Coronary Artery Bypass Grafting Revisited: Experience and Evidence from Japan

“…Nakjima, et al 56) examined the detailed characteristics of the arterial composite and sequential grafts and delineated the risk factors of graft occlusion. Intermediate graft patency of the graft with competitive or reverse flow was much lower when it was grafted to the coronary artery with mild disease or the main trunk of the LAD.…”

New device for intraoperative graft assessment: HyperEye charge-coupled device camera system

“…Nakajima et al defi ned competitive fl ow assessment by X-ray angiography as the target vessel was barely opacifi ed from the ITA graft injection and the bypass graft was fi lled by retrograde fl ow from the native coronary injection that was a functionally patent graft. 17 According to this defi nition, when the HyperEye system captured both to-and fro fl ow and patent perfusion that is dependent on diastolic graft fl ow, based on those images we diagnosed a functionally patent graft. Hence, we believe that visualization of perfusion fl uorescence using the HyperEye system has an advantage over TFM for intraoperative competitive fl ow assessment.…”