Conduits for Coronary Artery Bypass Surgery

Abstract

Since its first introduction coronary artery bypass grafting (CABG) has become one of the mainstays in the treatment of ischemic heart disease. Both arterial and venous conduits as well as a variety of their combinations can be used. Long saphenous vein is the predominantly used venous conduit. Left internal thoracic artery (LITA), right internal thoracic artery (RITA), radial artery (RA), and right gastroepiploic artery (RGEA) are currently in use as arterial grafts. Pedicled or skeletonized harvesting techniques have been described for arterial conduits with the latter being recommended for ITAs. Minimally invasive endoscopic harvesting techniques can be applied to radial artery and long saphenous vein. The latter can also be harvested preserving the tissue surrounding the vessel (no-touch technique) as it is thought to improve patency rate. Biological augmentation or physical reinforcement of saphenous vein grafts (SVG) is also being proposed to improve patency. As far the grafting strategy is concerned, there is an established consensus on the use of arterial conduit on the left anterior descending coronary due to the well-established prognostic benefit. The choice of the second and further conduits for the remaining targets is still an area of debate due to the discrepancy in outcomes observed among randomized and large retrospective studies published in the literature. However, recent meta-analyses are pointing at the superiority of an arterial strategy in terms of long-term patency and outcomes. On the basis of the evidence currently available and on the basis of the long-term results of previous and new randomized controlled trials (RCTs), a multiple arterial grafting strategy should be the preferred approach in the majority of the patients and an ad hoc decisional algorithm has been recently suggested in this chapter.