Unanswered questions on coronary artery graft patency and clinical outcomes

Abstract

Purpose of reviewTo review current issues related to coronary artery graft patency and outcomes.Recent findingsThe association of coronary artery graft patency with clinical outcomes is a traditional concept; however, it has been challenged by the results of numerous studies. Key limitations of the existing evidence include the lack of a universal definition of graft failure, the absence of systematic imaging in contemporary coronary artery bypass grafting trials, the reliance on observational data with inherent selection and survival bias, and high attrition rates for follow-up imaging. Key modulators of graft failure, and of the relationship between graft failure and outcomes, include the type of conduit and myocardial territory grafted, conduit harvesting technique, and postoperative antithrombotic regimen and patient sex.SummaryThe relationship between graft failure and clinical events is complex and variable. Overall, the preponderance of current data suggests a possible association between graft failure and nonfatal clinical events.

Analysis of a multicenter registry on evaluation of transit-time flow in coronary artery disease surgery

“…In the context of coronary artery bypass graft (CABG) surgery, graft patency seems to play an important role in early and late postoperative outcomes. 1 , 2 Technical errors could be among the factors, in addition to various factors influencing graft patency, and although rare, objective assessment of graft and anastomosis quality by intraoperative measurement of graft flow (GF) should be welcomed. Although several studies have led transit-time flow measurement (TTFM) 3 , 4 , 5 to enter the guidelines, 6 it has not yet routinely adopted by surgical community as a standard of care, with an estimated use rate of only 30% of procedures.…”