Sequential Bypass Grafting on the Beating Heart: Blood Flow Characteristics

Gwozdziewicz, Marek; Němec, Petr; Šimek, Martin; Troubil, Martin

doi:10.1016/j.athoracsur.2005.12.069

Cited by 12 publications

(9 citation statements)

References 10 publications

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“…McNamara et al [29], however, concludes that there is no significant difference between single graft and multiple grafts. This is in agreement with a recent work [30] that predicted similar patency of both single and sequential types of bypass. Al-Ruzzeh et al [31] have shown that the combination of sequential bypass grafting and off-pump techniques was safe, and provided good early clinical and angiographic outcomes.…”

Section: Patency Of Cabg Proceduressupporting

confidence: 94%

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Sankaranarayanan

Ghista

Chua

et al. 2009

Computational Cardiovascular Mechanics

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Coronary artery bypass graft (CABG) is a major therapy for ischemic heart disease which if left untreated can progress to failure of the heart. Restenosis, a leading cause of CABG, can be correlated with the geometric configuration and the hemodynamics of the graft. In this chapter we use computational fluid dynamics (CFD) to investigate the hemodynamics in a 3D out-of-plane sequential bypass graft model. Using a finite volume approach, quasi-steady flow simulations are performed at mid-ejection and at mid-diastole. Plots of velocity vectors, wall shear stress (WSS), and spatial WSS gradient (WSSG) distribution are presented in the aorto-left coronary bypass graft domain. Simulation results reveal a more uniform WSS and spatial WSSG distribution in the side-to-side (sequential graft) anastomosis configuration over the end-to-side (multiple graft) anastomosis. Results for the multiple bypass graft model show the peak magnitudes of the spatial WSSG are higher compared to the sequential bypass graft model. These findings suggest that sequential bypass grafting may be preferable over multiple bypass grafting to avoid non-uniformities of WSS. IntroductionThe sequential coronary artery bypass grafting (CABG) technique, as described in early years [1,2], is a technique in which two or more coronary artery anastomoses are made with a single graft, usually the saphenous vein. The distal anastomosis is constructed in an end-to-side fashion, while the proximal anastomosis is constructed in a side-to-side fashion. The advantages of this technique over the single graft technique include fewer anastomoses and higher graft flow [3,4]. Higher patency rates have also been observed through post angiograms in the proximal side-to-side M. Sankaranarayanan (B) Mathematics,

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Section: Patency Of Cabg Proceduressupporting

confidence: 94%

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Sankaranarayanan

Ghista

Chua

et al. 2009

Computational Cardiovascular Mechanics

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“…The favorable effects of intraluminal flow characteristics (ie, mean flow and PI) on both the short-and long-term results reported in previous studies 7,8,10 agree with basic experimental studies showing the positive influence of flow characteristics in preventing adverse remodeling, neointimal proliferation, and atherosclerotic graft failure. [1][2][3][4][5][6][11][12][13][14][15] In chronic canine vascular implant models, flow velocity and wall shear stress correlated inversely with intimal hyperplasia. 10,12 Wentzel and colleagues 13 also noted a similar correlation between shear stress and the development of intimal hyperplasia-induced in-stent re-stenosis in human subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary CT angiograms were conducted routinely after coronary bypass surgery unless otherwise contraindicated. Baseline MDCT coronary images were obtained in the early postoperative period before discharge at a mean of 5.70 AE 1.87 days postoperatively and a median of 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Follow-up imaging studies were subsequently performed 1 and 3 to 5 years thereafter.…”

Section: Multi-detector Computed Tomography Coronary Angiographymentioning

confidence: 99%

“…Several studies have indicated the patency of sequential SV coronary bypass grafts to be superior to individual bypass grafts. [1][2][3][4][5][6] However, concerns regarding the potential risk of a high proximal occlusion causing major myocardial ischemic events have discouraged many surgeons from more actively using this technique. The present study was conducted to investigate the relationship between the coronary bypass grafting technique and both the hemodynamic flow characteristics and mid-term patency of SV grafts using transit time flow measurement (TTFM) and multi-detector computed tomography (MDCT) coronary angiogram.…”

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confidence: 99%

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The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting

Kim

Lee

Kim

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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“…During OPCAB procedure the heart was immobilized with two suction based stabilizers with all peripheral anastomoses being sutured on intracoronary shunts, as described previously 2 . The postoperative outcomes of both groups were analyzed, retrospectively.…”

Section: Methodsmentioning

confidence: 99%

The Choice of on- Or Off-Pump Coronary Bypass Grafting - A Surgeon's Dilemma

Gwozdziewicz¹,

Olsak²,

Lonský³

et al. 2008

BIOMED PAP

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Background: Off -pump coronary bypass grafting (OPCAB) is a routine method of heart revascularization. This study was designed to compare the results of OPCAB and ONCAB performed by a single surgeon at our institution over a 3-year period.Methods: The study enrolled 345 patients undergoing elective myocardial revascularization procedures, of which 173 (50.1%) were OPCAB and 172 (49.9 %) were ONCAB. The postoperative outcomes of both groups were analyzed, retrospectively.Results: The mean number of grafts was signifi cantly lower in the OPCAB group (2.9) than in the ONCAB group (3.7). There were no postoperative myocardial infarctions or hospital deaths in any of the patients. The postoperative total blood loss was signifi cantly higher in the ONCAB group. The frequencies of postoperative confused states, strokes, postoperative transfusions, reoperations for bleeding, and atrial fi brillation, and the durations of intubation, ICU stay, and hospital stay did not diff er signifi cantly between the two groups.Conclusions: The OPCAB procedures are safe and provide good clinical outcomes, similar to those of ONCAB operations. The outcomes of this study favor neither of the compared techniques.

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Sequential Bypass Grafting on the Beating Heart: Blood Flow Characteristics

Cited by 12 publications

References 10 publications

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

Blood Flow in an Out-of-Plane Aorto-left Coronary Sequential Bypass Graft

The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting

The Choice of on- Or Off-Pump Coronary Bypass Grafting - A Surgeon's Dilemma

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