The Choice of Graft Conduits in Coronary Artery Bypass Grafting

Abstract

The use of the left internal mammary artery (IMA) has been shown to improve longterm survival and has been a gold standard in coronary artery bypass grafting (CABG). However, the choice of second or third graft conduit is still controversial. Multiple studies demonstrated the beneit of using multiple arterial grafts such as right IMA and radial artery in addition to left IMA in terms of long-term survival and graft patency. However, most of the centers still perform CABG with one IMA and vein grafts in a real world. The challenges for bilateral IMA utilization include longer operative time and concerns for higher rates of perioperative morbidity and mortality associated with increased sternal wound infection. Several studies reported that skeletonization technique can reduce the risk of sternal wound infection. Radial artery is another arterial conduit, which does not increase the risk of sternal wound infection and is easy to harvest. The superiority between radial artery and right IMA has been controversial. In the meantime, multiple trials have been made to improve the patency of vein grafts. The choice of graft conduits in CABG should be well considered preoperatively based on each patient's backgrounds.

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“…The findings of the study displayed that SV+IMA was the most frequently used Graft in the surgical management of Ischemic Heart Disease. This could be explained that the SV is the most frequent used conduit and IMA is the most optimal type of graft [23]. It was also found that (CABG + 3 Grafts) was the most frequent surgeries done for ischemic heart disease patients in Al-Thawrah Hospital.…”

Assessment of renal function and prevalence of acute kidney injury following coronary artery bypass graft surgery and associated risk factors: A retrospective cohort study at a tertiary care hospital in Islamabad, Pakistan

“…Coronary artery bypass graft (CABG) surgery is a common surgical procedure (0.4 million surgeries/annum) [1] with good survival rate and reduced cardiovascular complications. [2] Acute kidney injury (AKI) is defined as a sudden decline in renal function following cardiac surgery with an increase in serum creatinine (S.Cr), decrease in urine output, or both.…”

A comparative study on fatty acid profile in selected vessels of coronary artery bypass graft (CABG)

“…The success of coronary artery bypass grafting (CABG) which is one of the common surgical techniques used to improve the blood flow in the heart is dependent on the long-term patency of arterial and venous grafts [2]. The majority of patients receive left internal mammary artery (LIMA) grafts to the left anterior descending (LAD) coronary artery compared to other grafting options such as saphenous vein (SV) grafts or radial artery (RA) [3]. According to literature, the LIMA is considered a superior graft for long-term patency when compared to a vein graft [4].…”