The Patency of Sequential and Individual Saphenous Vein Grafts after Off-pump Coronary Artery Bypass Grafting

Gao, Changqing; Wang, Mingyan; Wang, Gang; Xiao, Chen; Wu, Yaling; Li, Bojun; Ye, Weihua

doi:10.1111/j.1540-8191.2010.01145.x

Cited by 16 publications

(19 citation statements)

References 17 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ROOBY trial randomized 2203 patients to "on-pump" or "offpump" CABG and looked at rates of graft patency at 30 days and 1 year. 76 A systematic review and meta-analysis of 12 cohort studies has also shown that the risk of graft failure was lower in sequential grafts than single vein grafts. However, at 1 year, follow-up angiograms in 1371 patients who underwent 4093 grafts showed that the overall rate of graft patency was lower in the "off-pump" group than in the "on-pump" group (82.6% vs. 87.8%, P < 0.01).…”

Section: Surgical Techniques and Svg Patencymentioning

confidence: 99%

Saphenous Vein Graft Disease

Kim

Marhefka

Ruggiero

et al. 2013

Cardiology in Review

View full text Add to dashboard Cite

Saphenous vein graft (SVG) disease after coronary artery bypass grafting (CABG) occurs in three phases: thrombosis, intimal hyperplasia, and atherosclerosis. Within the first month, thrombosis plays a major role. From month 1 to month 12, intimal hyperplasia occurs. Beyond 12 months, atherosclerosis becomes the primary cause for late graft failure. Endothelial damage has been shown to be the major underlying pathophysiology of SVG disease. Many factors contribute to endothelial damage from the moment the vein is harvested to when the vein is grafted into an arterial environment. To address this disease process, various therapeutic modalities, from surgical methods to medical treatment, have been evaluated. Surgically, the technical method of harvesting the vein has been shown to affect SVG patency. From a pharmacologic perspective, only two guideline class I recommended medications, aspirin and statins, have been shown to improve short- and long-term SVG patency after CABG. Despite these surgical and medical advances, SVG disease remains a significant problem with 1-year patency rates of 89% dropping to 61% after 10 years. This review discusses the pathogenesis of SVG disease, predictors of SVG failure, and current surgical and pharmacologic therapies to address SVG disease, including possible future treatment.

show abstract

Section: Surgical Techniques and Svg Patencymentioning

confidence: 99%

Saphenous Vein Graft Disease

Kim

Marhefka

Ruggiero

et al. 2013

Cardiology in Review

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5] Since its inception, several modifications have been proposed to improve the graft patency, including the choice of conduits, [6][7][8] target coronaries selection, 9,10) and the application of sequential grafting. 11,12) Sequential grafting is a surgical technique, where more than one distal anastomosis is constructed per single conduit, thus resulting in two or more distal anastomoses per single proximal anastomosis. The strategy of sequential grafting of saphenous vein (SV) has been accepted by a majority of cardiac surgeons.…”

mentioning

confidence: 99%

“…The strategy of sequential grafting of saphenous vein (SV) has been accepted by a majority of cardiac surgeons. [11][12][13] With the development of coronary surgery, an increasing number of patients who suffered from coronary artery disease with diffuse coronary disease or who received repeat CABG with limited available conduits pre-ferred surgical revascularization. Accordingly, the use of sequential SV grafting was likely to increase.…”

mentioning

confidence: 99%

Sequential Saphenous Vein Coronary Bypass Grafting

Song²,

Xia³

et al. 2018

Int. Heart J.

View full text Add to dashboard Cite

The enormous majority of previous reports focused on evaluating the safety and efficacy of sequential saphenous vein (SV) coronary bypass grafting; however, no reports to date have revealed concern regarding the impacts of the number of distal anastomoses of sequential SV grafting on graft patency after coronary artery bypass grafting (CABG). This single-center retrospective study aimed to evaluate the impacts of three versus two distal anastomoses per single SV conduit on SV graft patency after off-pump CABG, and to determine the independent risk factors for sequential SV graft failure. From January 2011 to December 2014, 1320 eligible patients were assigned to either a triple group (three distal anastomoses of sequential SV grafting, n = 758) or a double group (two distal anastomoses of sequential SV grafting, n = 562). The primary endpoint was over a 2-year follow-up SV graft failure after off-pump CABG. The triple and double group received a similar total patency rate of sequential SV conduits (86.5% versus 87.1%, P = 0.757). The number of distal anastomoses of sequential SV grafting (three versus two) was not a predictive factor for the follow-up graft failure of sequential SV conduits (HR = 0.91, 95% CI: 0.66-2.29, P = 0.137). Moreover, the two groups received a similar follow-up survival freedom from repeat revascularization (χ 2 = 1.881, log-rank P = 0.170). Three versus two distal anastomoses per single SV conduit received a similar SV graft patency. The number of distal anastomoses of sequential SV grafting was not an independent risk factor for graft failure.

show abstract

“…Although, its long-term patency was reported better than the single grafts, the technical aspect of sequential anastomosis is more complex, which explains the inconsiderable appliance. 1,2 Herein, we present a case with coronary bypass grafts in which the venous graft was anastomosed to obtuse marginal (OM) 1 and OM2 branches sequentially. Coronary angiography revealed complete obstruction of proximal graft, whereas the segment between OM1 and OM2 was patent with critical stenosis.…”

mentioning

confidence: 99%

“…First of all, sequential graft anastomosis may have a longer patency rate, which supports the previous literature. 1,2,4 Even in the complete obstruction of the proximal graft, the bridging segment may remain patent in the case of weak distal runoff from the native vessel. Second, PCI could be performed for bridging a Keywords ► cardiac catheterization ► cardiac surgery ► cardiovascular disease ► coronary artery ► coronary intervention ► graft repair ► greater saphenous vein…”

mentioning

confidence: 99%

Percutaneous Intervention of Sequential Coronary Venous Graft

2014

View full text Add to dashboard Cite

Sequential and composite coronary bypass grafting is less commonly preferred. Although, its long-term patency was reported better than the single grafts, the technical aspect of sequential anastomosis is more complex, which explains the inconsiderable appliance. 1,2 Herein, we present a case with coronary bypass grafts in which the venous graft was anastomosed to obtuse marginal (OM) 1 and OM2 branches sequentially. Coronary angiography revealed complete obstruction of proximal graft, whereas the segment between OM1 and OM2 was patent with critical stenosis. There was also total occlusion of the circumflex (CX) artery after branching of OM1. We performed percutaneous intervention to proximal CX, OM1, and bridging segment of the venous graft. Finally, bridging segment of the venous graft began to function as a CX body extending between the OM1 and OM2.A 56-year-old male patient presented with Canadian Cardiovascular Society class 3 angina pectoris. He was diabetic and had undergone a coronary bypass operation 7 years ago. Coronary angiography showed total left anterior descending artery occlusion with patent left internal mammary artery graft, total right coronary artery occlusion with occluded venous graft, proximal critical stenosis in CX and total occlusion after the OM1 branch. There was sequential venous graft anastomosed to OM1 and OM2 that occluded from the osteum (►Fig. 1). However, the segment of venous graft bridging OM1 and OM2 was functional with critical stenosis. Therefore, percutaneous coronary intervention (PCI) was performed to CX. After balloon dilation, subsequent three stent implantation was deployed to proximal CX, OM1 and bridging segment of venous graft extending to OM2. The final view demonstrated the functional and visual conversion of the venous graft to the CX body (►Fig. 1). The patient was discharged without complications and the first month control examination, including a stress test was normal.PCI regarding venous graft is still a challenging procedure because of the higher incidence of complications. Thus, PCI of venous graft older than 3 years is indicated if the native vessel could not be opened. 3 In our case, we tried to open native CX initially. After an unsuccessful native vessel intervention, venous graft intervention was performed without any complication. A subsequent stent deployment led to the rearrangement of CX artery and the bridging part of the venous graft looked like a native CX body. According to our case, we can conclude two important outcomes. First of all, sequential graft anastomosis may have a longer patency rate, which supports the previous literature. 1,2,4 Even in the complete obstruction of the proximal graft, the bridging segment may remain patent in the case of weak distal runoff from the native vessel. Second, PCI could be performed for bridging a Keywords ► cardiac catheterization ► cardiac surgery ► cardiovascular disease ► coronary artery ► coronary intervention ► graft repair ► greater saphenous vein AbstractWe present a case with coronary bypass ...

show abstract

The Patency of Sequential and Individual Saphenous Vein Grafts after Off-pump Coronary Artery Bypass Grafting

Abstract: The mid-term patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one.

Cited by 16 publications

References 17 publications

Saphenous Vein Graft Disease

Saphenous Vein Graft Disease

Sequential Saphenous Vein Coronary Bypass Grafting

Percutaneous Intervention of Sequential Coronary Venous Graft

Contact Info

Product

Resources

About