Treatment of Coronary Artery Bypass Graft Failure

Beijk, Marcel A.M.; Harskamp, Ralf E.

doi:10.5772/54928

Cited by 7 publications

(6 citation statements)

References 234 publications

(215 reference statements)

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“…Furthermore, competitive flow and low-flow profoundly affect graft patency. A proximal low-grade graft stenoses in the target artery are a major cause of competitive flow, which may lead to a decrease in antegrade flow in the arterial graft causing early failure ('disuse atrophy') [23]. Although the incidence of atherosclerosis is lower in arterial grafts, some other important morphologic changes may play a part in late graft failure like fibrointimal proliferation and fibrosis of organized thrombus.…”

Section: The Representation Of Prior Cabg Patients In Acs Trialsmentioning

confidence: 98%

Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome

Al-Aqeedi

Suwaidi

2014

Expert Review of Cardiovascular Therapy

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Generally, patients with prior coronary artery bypass graft (CABG) are often under-represented in acute coronary syndrome (ACS) clinical trials. Nevertheless, there is growing global attention concerning their short- and long-term prognosis. Some reports suggest prior CABG as an independent risk factor for increased mortality, while others report an equal or a more favorable prognosis despite their adverse baseline clinical characteristics. The reasons for this 'risk-mortality paradox' need to be further evaluated. More recent reports showed a significant reduction in in-hospital morbidity and mortality over a 20-year period of follow up that may be attributed to the improvement in surgical CABG techniques and increased use of evidence-based therapies over the past two decades. In the current review we discuss the available literature regarding outcomes of prior CABG patients who are presenting with ACS.

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Section: The Representation Of Prior Cabg Patients In Acs Trialsmentioning

confidence: 98%

Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome

Al-Aqeedi

Suwaidi

2014

Expert Review of Cardiovascular Therapy

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“…When an SVG is connected to the artery system, it changes its physiologic pressure flow dynamics and undergoes adaptive remodeling, which begins with fibrointimal hyperplasia. 7 This hyperplasia creates the nidus for atherosclerosis to emerge, which takes 5 to 10 years to develop and is commonly accompanied by thrombus and friability.…”

Section: Saphenous Vein Graft Disease Pathophysiologymentioning

confidence: 99%

“…Technical failure or thrombosis are the most common reasons, occurring most commonly at the site of anastomosis, owing to graft endothelial injury during harvesting, which promotes platelet adhesion, and thus thrombosis, as well as high pressure distension to check graft appropriateness, which damages the intima, exposing the media to even before the graft is used. 7 Vasospasm is caused by shear stress caused by arterialized flow damaging the endothelium.…”

Section: Saphenous Vein Graft Disease Pathophysiologymentioning

confidence: 99%

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Saphenous Vein Graft Disease Interventions

Rao

Kumar

2021

Indian J Cardiovasc Dis Women WINCARS

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In the current era, coronary artery bypass grafting (CABG) is being increasingly performed using total arterial revascularization or a hybrid procedure of stenting of non-LAD disease and minimal access left internal mammary artery (LIMA) to LAD grafts, in order to minimize the need for vein grafts. Still, we encounter saphenous vein graft (SVG) disease, and it might require PCI, which often presents with unique challenges. The current favored strategy is to attempt PCI of the native coronary, if feasible, especially in long degenerated SVG disease, as it has shown better short- and long-term outcome. PCI is preferred over repeat CABG for early recurrent symptoms after CABG in patent LIMA graft and amenable anatomy patients. Balloon predilatation is not recommended unless delivery of an EPD or stent is not possible. Distal protection should be considered the standard of care for percutaneous coronary intervention (PCI) in most patients with older vein grafts, as periprocedural myocardial infarction and no reflow are the Achilles heel of SVG PCI. Intragraft vasodilators should be used liberally, even before balloon angioplasty/stenting. Avoid postdilatation, and usage of undersized but a longer stent length to reduce plaque extrusion through stent struts is preferred. Consider thrombectomy in lesions with a heavy thrombus burden. Keep activated clotting time on the higher side than in conventional PCI. Prolonged dual antiplatelet therapy (DAPT) based on the DAPT score is recommended. With all the precautions and care, we still need a fair wind in our favor to sail through the vein grafts disease.

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“…However, when the native coronary artery’s stenosis is not serious, some blood can still flow through it, and this blood flow through the native coronary artery is called competitive flow. For LIMA grafts, competitive flow reduces the blood flow within the graft and, in severe cases, leads to the string phenomenon ( Seki et al, 1992 ; Villareal and Mathur, 2000 ; Beijk and Harskamp, 2013 ; Halfwerk et al, 2021 ). At present, the method to determine the occurrence of competitive flow is to clamp the native coronary artery and measure graft flow again.…”

Section: Introductionmentioning

confidence: 99%

A Novel Method to Determine the Cause of Left Internal Mammary Artery Instant Non-Patency Based on Transit Time Flow Measurement

et al. 2022

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Objective: After coronary artery bypass grafting (CABG) surgery, the main causes of poor instant patency of left internal mammary arteries (LIMAs) are competitive flow and anastomotic stenosis, but how to determine the cause of LIMA non-patency without interfering with the native coronary artery is still a difficult problem to be solved urgently.Methods: In this study, a 0D-3D coupled multiscaled CABG model of anastomotic stenosis and competitive flow was constructed. After calculation, the flow waveform of the LIMA was extracted, and the waveform shape, common clinical parameters (average flow, PI, and DF), and graft flow FFT ratio results (F0/H1 and F0/H2) were analyzed.Results: For LIMA, these three common clinical parameters did not differ significantly between the anastomotic stenosis group and competitive flow group. However, the waveform shape and FFT ratio (especially F0/H2) of the competitive flow group were significantly different from those of the anastomotic stenosis group. When the cause was competitive flow, there was systolic backflow, and F0/H2 was too high (>14.89). When the cause was anastomotic stenosis, the waveform maintained a bimodal state and F0/H2 was in a normal state (about 1.17).Conclusion: When poor instant patency of the LIMA is found after CABG, the causes can be determined by graft flow waveform shape and F0/H2.

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Treatment of Coronary Artery Bypass Graft Failure

Cited by 7 publications

References 234 publications

Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome

Outcomes of patients with prior coronary artery bypass graft who present with acute coronary syndrome

Saphenous Vein Graft Disease Interventions

A Novel Method to Determine the Cause of Left Internal Mammary Artery Instant Non-Patency Based on Transit Time Flow Measurement

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