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

Abstract

Sequential bypass grafts were associated with higher mean flows and superior mid-term patency compared with individual grafts. These findings suggest the more favorable results of sequential bypass grafting to be attributed to the enhanced flow hemodynamics.

Intra-operative Graft Blood Flow Measurements for Composite and Sequential Coronary Artery Bypass Grafting

“…Increased graft flow rate has been associated with decreased SVG intimal proliferation (15). Some series have reported better TTF measurements (16,17) or patency (15,18) results with sequential grafting strategy compared to single graft while others have not (19)(20)(21). A meta-analysis of 12 studies comparing the patency of sequential and individual vein grafts concluded that the mid-and long-term patency of sequential vein grafts were superior to single vein grafts (14).…”

The application of intraoperative transit time flow measurement to accurately assess anastomotic quality in sequential vein grafting

“…Based on a complex mathematical analysis of the flow curve, it is suggested that a stenosis causing a 50% or greater narrowing of anastomoses can affect graft flow substantially and enable detection by TTFM [25]. In addition, it has been found that the transit time blood flow in a sequential graft is substantially higher than that in a single graft [11,17], which could further mask the effect of a less-than-critical defective anastomosis on the total graft flow. We believe that the two anastomotic defects identified by the flow reduction method might not be so critical as to significantly reduce the total graft flow.…”

“…A number of studies have demonstrated that intraoperative TTFM can be used to assess early graft function and to predict graft error in CABG, thus allowing for prompt revision of anastomotic imperfection and prevent graft failure [13][14][15][16]. Intraoperative TTFM has also been used to examine the haemodynamics of total graft blood flow in sequential vein grafts [11,17]. Nordgaard et al [11] and Kim et al [17] used intraoperative TTFM to compare the haemodynamic characteristics of blood flow between sequential vein grafting and individual grafting and found that the total blood flow in sequential vein grafts is significantly higher than that in a single vein graft.…”

“…Intraoperative TTFM has also been used to examine the haemodynamics of total graft blood flow in sequential vein grafts [11,17]. Nordgaard et al [11] and Kim et al [17] used intraoperative TTFM to compare the haemodynamic characteristics of blood flow between sequential vein grafting and individual grafting and found that the total blood flow in sequential vein grafts is significantly higher than that in a single vein graft. Because of the complex haemodynamic characteristics of blood flow in a sequential graft and the complexity of coronary artery branching, the flow characteristics associated with total graft flow in a sequential graft might not accurately indicate the quality of each distal anastomosis in the sequential graft.…”

The Year in Review: Surgical Revascularization of Coronary Artery Disease-2011

“…Nevertheless, in view of the known limitations of saphenous vein grafts, the study implies that caution should be used when employing these conduits to revascularize larger areas of ischemic myocardium with sequential techniques. The impact of sequential versus single vein graft anastomosis on graft flow and patency was also studied by Kim and co‐workers in 3009 patients 50 . Sequential vein grafts had higher flow as measured by transit time flow meters (p = 0.001).…”