Role of prosthetic conduits in coronary artery bypass grafting

Abstract

Prosthetic grafts are required for coronary artery bypass grafting (CABG) when the availability of suitable autologous conduits is limited. The ideal cardiovascular bypass graft requires a broad range of characteristics including strength, viscoelasticity, biocompatibility, blood compatibility and biostability. Many alternative conduits have been developed and used in the past, but most of them have failed, except in rare instances. This review aims to analyse the current status of their use and prospects for the future. We performed a literature search on PubMed using the generic terms 'conduits for coronary artery bypass grafting'; 'reoperative coronary artery bypass grafting'; 'redo coronary artery bypass grafting'; 'PTFE'; 'Dacron or PET'; 'gastroepiploic artery'; 'inferior epigastric artery'; 'biological grafts'; 'tissue-engineered grafts'; 'synthetic grafts'; 'prosthetic grafts'; 'polyurethane grafts'; 'cephalic veins'; 'short saphenous vein;' and 'alternative conduits'. In addition, we searched through related citations and references from selected articles. A total of 1253 references and 110 full-text articles were reviewed, and they were further selected based on available information. This review concludes that, over the past three to four decades, achieving the goal of a prosthetic graft with equivalent function and durability to the internal mammary artery or long saphenous vein has proved to be elusive.