Total arterial coronary grafting: outcomes, concerns and controversies

Raja, Shahzad G.

doi:10.20517/2574-1209.2019.05

Cited by 7 publications

(5 citation statements)

References 48 publications

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“…For the other 12 surgeons, the BIMA use was only 14.45% (0–25%). This variability is consistent with 20% TAG utilization in Europe, up to 80% in some Australian centers ( 39 ) and 3% overall BIMA usage on multi-institutional analysis ( 40 ). A further subgroup analysis is planned as an extension to this study to investigate the effect of surgeon experience on engagement with information provided by the computational modeling.…”

Section: Discussionsupporting

confidence: 77%

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: Discussionsupporting

confidence: 77%

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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“…7 Total arterial revascularization became an alternate option to saphenous vein grafts to improve the long-term outcomes after CABG; however, the superiority of this approach is still debated. 8 Total arterial revascularization has the potential advantage of a better patency rate, lower myocardial infarctions and reoperations, and a better survival rate. 9 This study compared total arterial revascularization strategy and conventional CABG with long saphenous vein grafts.…”

Section: Discussionmentioning

confidence: 99%

Total Arterial Revascularization versus Conventional Coronary Artery Bypass Grafting; A Comparative study

Elgharabawi

Gamil²,

Mahmoud³

et al. 2022

Al-Azhar International Medical Journal

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Background: The superiority of total arterial revascularization over the conventional method is a matter of continuous debate. Aim of the study: To compare early surgical and hospital outcomes of the total artery and conventional revascularization strategies in patients undergoing coronary artery bypass grafting (CABG).Patients and Methods: The study included 60 patients who underwent primary elective CABG from 2018 to 2020. Patients were grouped according to the revascularization strategy into two groups. Group 1 included patients who had conventional revascularization using left internal mammary artery (LIMA) and vein grafts (n= 30), and group 2 included patients who had total arterial coronary revascularization (TACR) (n= 30). Result: Patient who had TACR were significantly younger (48.43 ± 11.72 vs. 55.63 ± 3.97 years; P= 0.003). TACR patients had shorter cardiopulmonary bypass (53.70 ± 9.91 vs 61.83 ± 9.60 min; P= 0.002) and ischemia times (38.20 ± 7.78 vs 44.03 ± 7.23 min; P= 0.004). Blood loss and transfusion were significantly higher in patients in the conventional group (P= 0.01 and ˂0.001, respectively). TACR was associated with shorter mechanical ventilation (3.83 ± 0.95 vs. 4.80 ± 1.40 hours; P= 0.003), ICU (1.13 ± 0.35 vs. 1.47 ± 0.51 days; P= 0.004) and hospital stay (4.47 ± 0.63 vs. 6.04 ± 0.71 days; P= 0.001). After six months, angina and dyspnea classes were significantly better in the TACR group. Conclusion:The debate about the optimal CABG conduit is ongoing. Total arterial revascularization could be associated with favorable short and mid-term results.

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“…Finally, in the pursuit of TAR, there still needs to further compelling data from RCT to support TAR's use in standard practice 58 . It is also suggested that to achieve TAR, higher levels of surgical dexterity is needed, requiring more intensive training and experience before being able to successfully achieve TAR 9 .…”

Section: Discussionmentioning

confidence: 99%

Internal mammary harvesting: Techniques and evidence from the literature

et al. 2020

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Coronary artery bypass graft (CABG) is one of the most commonly performed cardiac surgeries in the world. CABG using the internal mammary artery (IMA) remains the gold standard intervention for myocardial intervention in multivessel coronary artery disease. IMA harvesting can be performed with various techniques and approaches: pedicled vs skeletonized harvesting technique as well as approaches such as conventional sternotomy, robotic and endoscopic approaches. While each technique and approach have their respective advantages and disadvantages, evidence remains varied between cohorts. Traditionally, IMA has been used as an in situ conduit; however, IMA free grafts also provide satisfactory outcomes in certain situations. This literature review aims to explore the efficacy of different techniques and approaches of IMA harvesting and grafting. With evidence compiled, this will provide an overview of the complexity of CABG and locate gaps in current literature to direct future research. K E Y W O R D S coronary artery bypass, harvesting technique, internal mammary

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Total arterial coronary grafting: outcomes, concerns and controversies

Cited by 7 publications

References 48 publications

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

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

Total Arterial Revascularization versus Conventional Coronary Artery Bypass Grafting; A Comparative study

Internal mammary harvesting: Techniques and evidence from the literature

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