The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases

Prapas, Sotirios; Pangiotopoulos, Ioannis A; Leivaditis, Vasileios; Katsavrias, Konstantinos P; Prapa, Vasiliki S; Linardakis, Ioannis N.; Koletsis, Efstratios; Grapatsas, Konstantinos

doi:10.1177/1179065219871948

Cited by 3 publications

(3 citation statements)

References 55 publications

(61 reference statements)

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“…A composite Y-graft can be constructed using the RA off the in situ LIMA to LAD and if the in situ RIMA cannot reach the RCA target then it is lengthened by a small I-graft with the remaining RA ( 15 ) (configuration E) ( Figure 2E ). An alternative configuration involves the RIMA in the Y-composite graft which spares the LIMA to be used as an individual graft ( 16 ) (configuration F) ( Figure 2F ). Certain surgeons perform a double-Y graft to revascularize all three territories and this is based on a single inflow ( 17 ) (configuration G) ( Figure 2G ).…”

Section: Methodsmentioning

confidence: 99%

Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts

Chaudhuri

Pletzer

Waqanivavalagi

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesFlow competition between coronary artery bypass grafts (CABG) and native coronary arteries is a significant problem affecting arterial graft patency. The objectives of this study were to compare the predictive hemodynamic flow resulting from various total arterial grafting configurations and to evaluate whether the use of computational fluid dynamics (CFD) models capable of predicting flow can assist surgeons to make better decisions for individual patients by avoiding poorly functioning grafts.MethodsSixteen cardiac surgeons declared their preferred CABG configuration using bilateral internal mammary and radial arteries for each of 5 patients who had differing degrees of severe triple vessel coronary disease. Surgeons selected both a preferred 'aortic' strategy, with at least one graft arising from the ascending aorta, and a preferred “anaortic” strategy which could be performed as a “no-aortic touch” operation. CT coronary angiograms of the 5 patients were coupled to CFD models using a novel flow solver “COMCAB.” Twelve different CABG configurations were compared for each patient of which 4 were “aortic” and 8 were “anaortic.” Surgeons then selected their preferred grafting configurations after being shown predictive hemodynamic metrics including functional assessment of stenoses (instantaneous wave-free ratio; fractional flow reserve), transit time flowmetry graft parameters (mean graft flow; pulsatility index) and myocardial perfusion.ResultsA total of 87.5% (7/8) of “anaortic” configurations compared to 25% (1/4) of “aortic” configurations led to unsatisfactory grafts in at least 1 of the 5 patients (P = 0.038). The use of the computational models led to a significant decrease in the selection of unsatisfactory grafting configurations when surgeons employed “anaortic” (21.25% (17/80) vs. 1.25% (1/80), P < 0.001) but not “aortic” techniques (5% (4/80) vs. 0% (0/80), P = 0.64). Similarly, there was an increase in the selection of ideal configurations for “anaortic” (6.25% (5/80) vs. 28.75% (23/80), P < 0.001) but not “aortic” techniques (65% (52/80) vs. 61.25% (49/80), P = 0.74). Furthermore, surgeons who planned to use more than one unique “anaortic” configuration across all 5 patients increased (12.5% (2/16) vs. 87.5% (14/16), P<0.001).Conclusions“COMCAB” is a promising tool to improve personalized surgical planning particularly for CABG configurations involving composite or sequential grafts which are used more frequently in anaortic operations.

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Section: Methodsmentioning

confidence: 99%

Personalized surgical planning for coronary bypass graft configurations using patient-specific computational modeling to avoid flow competition in arterial grafts

Chaudhuri

Pletzer

Waqanivavalagi

et al. 2023

Front. Cardiovasc. Med.

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“…Furthermore, hybrid conduit techniques, such as the application of T-or Y-grafts and bilateral internal mammary arteries (BIMA), offer innovative solutions for specific clinical cases. These insights can aid surgeons in making informed decisions, leading to improved patient outcomes and long-term success of coronary artery bypass surgery [26][27][28][29][30].…”

Section: Choices Of Graftsmentioning

confidence: 99%

The choice of conduits in coronary artery bypass surgery

Panagiotopoulos,

Leivaditis,

Sawafta

et al. 2023

Arch Med Sci Atheroscler Dis

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Choosing appropriate bypass conduits is important in the consideration of long-term outcomes after surgical revascularization. When deciding on a grafting strategy, attention should be given to technical, anatomic, and angiographic determinants of conduit properties, as well as the clinical characteristics of the patient. The aim of the study was to present a current review of available choices of conduits in coronary artery bypass surgery. To date, only 4 conduits have proven to be effective: the saphenous vein (SVG), the internal mammary arteries (IMAs), the radial artery (RA), and the right gastroepiploic artery (RGEA). The IMA has unique biological properties that confer protection to intimal growth and atherosclerotic plaque formation, making it the conduit of choice for coronary artery bypass grafting. SVG exhibits a lower patency rate than those of IMAs. The RGEA allows revascularization of the inferior wall but is less commonly used, given that it is more prone to spasms.

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“…For example, on-pump CABG is related to more complete revascularization, increased formation of distal anastomosis, increased long-term survival, is more familiar to the majority of surgeons, and it is considered also an appropriate option in demanding situations. 9,10 Οff-pump CABG, on the other hand, is regarded as technically demanding and requires a prolonged learning curve; however, it has been associated with decreased levels of post-CABG inflammatory cytokines, reduced occurrence of postsurgical microemboli, and lower morbidity. 11 Even so, no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG regarding hard outcomes such as myocardial infarction, stroke, or death.…”

mentioning

confidence: 99%