Artery Graft Research Articles

Radial Artery Used as Conduit for Coronary Artery Bypass Grafting

It was in 1989 that we first reported on the use of the radial artery (RA) as a secondary arterial graft for coronary artery bypass grafting (CABG). Nevertheless, discrepancies in clinical endpoints between the RA and alternative conduits have been reported in consecutive randomised trials. With over fifty years of accumulated practice in RA bypass grafting, we sought to identify the second-best option for CABG by reviewing the literature. A consistently successful second-best conduit for CABG has been demonstrated using the radial artery. Compared to saphenous vein grafts, the findings indicate improved outcomes and better patency results. Furthermore, it has been demonstrated to be a safe and effective conduit in the territory of the right coronary artery. The lack of available literature and the scarcity of similar case series restrict the application of the gastroepiploic artery. After five decades of utilisation, it can be unequivocally stated that the radial artery is the optimal conduit for coronary bypass surgery following the left internal thoracic artery to the left anterior descending artery.

Risk Factors for Coronary Events After Robotic Hybrid Off-Pump Coronary Revascularization

Objectives: The impact of long-term complications after robotic hybrid coronary revascularization (HCR), including persistent angina, repeat revascularization, and myocardial infarction (MI), remains limited. This study aims to determine the risk factors for coronary events after robotic HCR and their time-varying effects on outcomes. Methods: We identified all consecutive patients who underwent robotic HCR at our institution. Baseline characteristics were explored as possible risk factors for angina, MI, and repeat revascularization with stents at any time during the follow-up. Results: A total of 875 patients (mean age 71.1 ± 11.1 years) were included. After a median follow-up of 3.32 years (IQR 1.18–6.34 years), angina occurred in 134 patients (15.3%), repeat revascularization with stents in 139 patients (15.8%), and MI in 36 patients (4.1%). The hazard rates for all outcomes increased with follow-up time, with a notable early rise around two years of follow-up for angina and, to a lesser extent, repeat revascularization. The risk factors were the lack of radial artery graft use, black race, diabetes, obesity, chronic obstructive pulmonary disease, low ejection fraction <50%, severe left main coronary artery stenosis (>50%), and more than three-vessel disease. Conclusions: Optimization of modifiable periprocedural risk factors may positively impact long-term prognosis in patients undergoing robotic HCR.

Impact of Multi versus Single Arterial Coronary Bypass Graft Surgery on Postoperative Atrial Fibrillation

The effect of multi-arterial (MA) versus single arterial (SA) coronary bypass graft surgery on postoperative atrial fibrillation (POAF) was not investigated. From May 2017 to May 2024, the patients with CYP2C19*2 or *3 allele receiving coronary artery grafting and post-operational aspirin 100 mg/day and clopidogrel 75mg/day were retrospectively reviewed and assigned into MA or SA group. The primary endpoint was the incidence rate of POAF in first week. The secondary endpoints were POAF burden, platelet aggregation, systemic immune-inflammation (SII) index and heart rate variability (HRV). The study included 58 cases in MA group and 174 cases in SA group. The incidence of POAF was 17% in MA group contrasting with 42% in SA group (hazard ratio: 0.353; 95% confidence interval: 0.218 to 0.569, P=0.0012). A lower POAF burden was observed in MA group than that in SA group (2 h [1, 5] versus 10 h [6, 20], P=0.02). Platelet aggregation (arachidonic acid, 46%±10% vs. 56%±8%, P<0.01; adenosine diphosphate, 58%±17% vs. 75%±13%, P<0.01) and inflammation response index (neutrophil-lymphocyte ratio, 26±4 vs. 28±5, P=0.006; SII index, 5019±771 vs. 5382±1204, P=0.032) was notably lower in MA group than those in SA group at one day after CABG. Holter electrocardiogram showed a higher HRV value in standard deviation of normal-to-normal RR intervals, and decreased low-frequency/high-frequency ratio in MA group. In conclusion, MA was associated with a lower incidence rate of POAF, and paralleled with a lower AF burden, platelet aggregation, inflammation reaction and a higher parasympathetic nerve tone compared with SA regimen.

Propensity-Matched Outcomes of Multivessel Robotic vs. Conventional Coronary Artery Grafting

Propensity-Matched Outcomes of Multivessel Robotic vs. Conventional Coronary Artery Grafting

Successful Use of Radial Artery Graft in Coronary Artery Bypass Grafting: A Case Report

Successful Use of Radial Artery Graft in Coronary Artery Bypass Grafting: A Case Report

Prognostic factors and outcome in patients submitted into coronary artery bypass surgery with total arterial myocardial revascularization

Background: Coronary artery bypass grafting relieves symptoms and improves survival in patients with severe coronary artery disease. Large series and meta-analyses show that total arterial myocardial revascularization (TAMR) may offer additional survival benefit. The primary objective of this study was to investigate long-term (&gt;5 years) survival of patients undergoing TAMR. The change in coronary artery disease risk factors during the follow-up period was also evaluated.Methods: Forty patients undergoing coronary artery bypass grafting (CABG) with total arterial myocardial revascularization (TAMR) were studied. All patients were screened for coronary artery disease risk factors at entry and follow-up. Repeat coronary angiography at a 5-year follow-up was used to investigate the long-term patency of arterial grafts.Results: Mean patient EuroSCORE was 1.42±1.1%. Mean follow-up time was 9.3±4.8 years (range: 1 month to 15.6 years). The 30-day mortality was 2.5% (1/40 patients), while the 12-month mortality was 7.5% (3/40 patients) with an actual survival of 92.5%. The 5-year and 10-year mortality was 15.8% (6/38 patients) and 33.3% (10/30 patients) respectively, while actual survival reached 84.2% and 66.7% at 5 and 10 years respectively. A total of 10/40 patients (25%) died during follow-up. Mean time-to-event was 3.5±2.7 years (range: one month to 7.1 years); 40% of deaths occurred during the first 2 years from the procedure, and 40% occurred during the period from 4.5 to 6.5 years post-surgery. The main cause of death was cerebrovascular disease in 30% of patients, while 20% died of cancer. 40% of fatalities were cardiac-related but not due to ischemic heart disease. The incidence of major adverse cardiac and cerebrovascular events (a composite outcome of cardiac-related death, myocardial infarction, need for revascularization and stroke) was 17.5% during follow-up. Total morbidity reached 30%. The use of the radial artery resulted in a similar survival to the use of bilateral internal mammary arteries exclusively. The numbers of grafts used were 39 Left internal mammary artery grafts (LIMA), 34 right internal mammary artery grafts (RIMA) and 24 right radial artery grafts (RAD). Repeat coronary angiography at a 5-year follow-up revealed that all arterial grafts were patent. Control of arterial hypertension (blood pressure &lt;30/80 mmHg) was achieved in 65% of patients postoperatively compared to 22.5% preoperatively (p=0.01).Conclusions: TAMR is safe and effective with encouraging results in terms of long-term survival. This is the first reported study investigating long-term outcomes in patients undergoing total arterial revascularization in Greece.

Enhancing Radial Artery Graft Patency: Perioperative Strategies and Clinical Insights in Coronary Artery Bypass Surgery

With the widespread adoption of multiple and total arterial coronary artery bypass grafting, the radial artery (RA) has regained favor among cardiac surgeons. The advent of antispasmodic medications, improvements in surgical techniques, and the selection of more suitable target conduits have led to numerous studies demonstrating significantly higher patency rates for the RA, thus broadening its application. This review discusses the historical development of arterial bypass grafts, the current use of the RA, and the effectiveness of perioperative management in maintaining the viability of the RA as a graft. It also addresses strategies to minimize perioperative factors that could impair the RA, thereby ensuring graft quality.

Arterial conduits for coronary bypass grafting: the set-point concept

Abstract Endothelial cells control the vascular tone of arterial grafts used for coronary artery bypass surgery and react to changes in local shear stress. The vascular adaptations induced by endothelial cell activation affect the outcome of surgical grafts and can be predicted based on the set-point theory. In this Hypothesis piece, it is proposed that the set-point concept should inform surgical decision making for coronary artery bypass surgery.

MODERN VIEWS AND APPROACHES TO THE CHOICE OF GRAFTS DURING CORONARY ARTERY BYPASS GRAFTING. PART 2: COMPARATIVE ANALYSIS OF DIFFERENT TYPES OF GRAFTS

It is known that coronary artery bypass grafting is still one of the main method of treatments from the point of increasing survival rates and avoidinig resergions and the risk of repeated interventions for most patients, in particular, in patients with multivessel coronary disease and diabetics. More than 45 years have passed since the first operation of coronary artery bypass grafting, and currently coronary artery bypass grafting is not only the most common operation in cardiovascular surgery, but also the “gold standard” for the treatment of the coronary heart disease. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. And the question of which grafts are more efficient and durable is becoming more and more urgent. The long-term benefit of the internal thoracic artery has long been proven and the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. It is not always possible to achieve complete revascularization with arterial grafts, which requires the use of venous grafts. Unfortunately, the saphenous vein graft does not have the same duration of functioning, which leads to the occurrence of dysfunctions and the development of repeated ischemic events. On the other hand, the radial and internal arteries are exposed to spasm and vulnerable to competitive blood flow In this paper, a detailed analysis of the main types of grafts in coronary surgery is carried out.

Sex difference in outcomes after coronary artery bypass grafting: follow-up data of the Netherlands Heart Registration.

Controversies exist regarding sex differences in outcomes after coronary artery bypass grafting (CABG). This study assessed sex differences in early and mid-term outcomes after CABG and factors associated with these differences. Outcomes were based on data from the Netherlands Heart Registration (NHR). Data of patients undergoing CABG in the Netherlands between 2013 and 2019 were retrieved from the NHR database. Primary outcomes were early mortality, morbidity and mid-term survival. The population was divided into subgroups based on age (≥ 70years and < 70years). Regression analyses investigated the correlation between sex and both early and mid-term mortality. This study included 41,705 male and 10,048 female patients. Median follow-up was 3.6 (1.8-4.8) years. Female patients were less likely to receive ≥ 2 arterial grafts (15.9% vs 23.2%, p < 0.001), had fewer anastomoses (3.2 ± 1.1 vs 3.5 ± 1.1, p < 0.001), higher 30-day mortality (1.9% vs 1.0%; p < 0.001) and alower mid-term survival rate (91.3% vs 93.1%, p < 0.001). Perioperative complications, including myocardial infarction and stroke, were more common in female patients (all p < 0.001). Women aged < 70years had alower mid-term survival rate than men < 70years (94.5% vs 96.0%, p < 0.001). Cox regression analysis showed that female sex was not significantly associated with mid-term mortality in the total cohort [hazard ratio (HR) 1.03; p = 0.45] but was associated with mid-term mortality in patients aged < 70years (HR 1.19; p < 0.001). Women undergoing CABG in our cohort presented with more complex risk profiles, received different surgical strategies and had worse early and mid-term outcomes compared to men. Female sex was associated with mid-term mortality only in patients < 70years of age.

The multi-center mid-term clinical outcomes of combined complete preservation of chordal structure mitral valve replacement with total anatomic complete arterial myocardial revascularization for coronary patients with moderate-to-severe or severe ischemic mitral regurgitation

Objective: To evaluate the clinical outcomes of combined complete preservation of chordal structure mitral valve replacement (C-MVR) with total anatomical arterial myocardial revascularization (TACR) in coronary patients with moderate-to-severe or severe ischemic mitral regurgitation (IMR). Methods: This is a retrospective multi-center case series study. Data were retrospectively collected from 127 patients with coronary artery disease with moderate to severe or severe IMR who received TACR with C-MVR from July 2015 to April 2024 in 13 hospitals in China. There were 90 males and 37 females, aged (56.5±10.7) years (range: 33 to 74 years). Perioperative data and follow-up data including left ventricular ejection fraction, left ventricular end-diastolic diameter, and patency rate of arterial grafts of patients were collected. Comparisons were made using paired sample t-test or χ2 test. Results: In this cohort of 127 patients, 67 underwent concurrent tricuspid valve repair. During surgery, 113 grafts of the left internal mammary artery (LIMA), 127 grafts of the left radial artery, 80 grafts of the right radial artery, and 110 grafts of the right internal mammary artery (RIMA) were harvested. The number of the distal anastomosis was 4.2±0.4 (range: 3 to 5). The aortic cross-clamp time and cardiopulmonary bypass time were (97.5±23.4) minutes (range: 90 to 161 minutes) and (145.4±19.2) minutes (range: 101 to 210 minutes), respectively. There was one operative death. Intraoperative placement of an intra-aortic balloon pump was performed in 21 patients to improve the left ventricular ejection. No sternal ischemic occurred. All patients completed follow-up, with a mean follow-up period of (64.3±7.5) months (range: 4 to 110 months). No major cerebrovascular events occurred during the follow-up period, and all patients survived. Left ventricular ejection fraction improved postoperatively (55.0%±5.3% vs. 41.0%±15.3%, t=17.23, P<0.01). The proportion of patients with New York Heart Association functional class ≤2 increased postoperatively (23.6% (30/127) vs. 87.3% (110/126), χ²=103.77, P<0.01). The proportion of patients with Canadian Cardiovascular Society Angina Classification ≤3 decreased postoperatively (4.8% (6/126) vs. 78.7% (100/127), χ²=142.19, P<0.01). The left ventricular end-diastolic diameter decreased postoperatively ((5.70±4.50) cm vs. (6.10±0.23) cm, t=12.15, P<0.01). Coronary multi-detector computed tomography angiography (MDCTA) follow-up was conducted for (60.5±11.7) months (range: 6 to 109 months) postoperatively. MDCTA confirmed the patency rates of the grafts: 96.4% (108/112) for the LIMA grafts, 88.9% (112/126) for the left radial artery grafts, 93.7% (74/79) for the right radial artery grafts, and 90.9% (100/110) for the free RIMA grafts. No significant differences in graft patency rates were observed between the arterial grafts (χ²=5.24, P=0.155). Conclusion: The results of this multi-centre study demonstrate satisfactory mid-term results of C-MVR with TACR for the treatment of coronary artery disease with moderate to severe or severe IMR.

Coronary-subclavian steal syndrome: A case series and review of the literature.

To report a case series of three patients with symptomatic coronary-subclavian steal syndrome (CSSS) and to review the literature on published case series. We retrospectively reviewed three cases of CSSS patients treated with open and endovascular surgery at a single center over a period of three decades (1996-2024). A comprehensive review of case series involving more than three patients was also performed. The first patient was a 65-year-old male with a 12-year history of coronary artery bypass grafting (CABG), presenting with unstable angina. Coronary angiography revealed a patent left internal mammary artery (LIMA) graft with retrograde flow through the left subclavian artery (LSA) and occlusion at the LSA ostium. He underwent a successful carotid-subclavian bypass, which significantly improved his symptoms. He died 6years later from heart failure. The second patient was a 73-year-old woman with a 15-year history of CABG and balloon angioplasty of the grafts. She presented with dyspnea, stable angina, and progressive functional decline. Critical stenosis in the LSA was identified, and her symptoms resolved after successful stent placement. She died 6years later from progressive heart failure. The third patient was a 75-year-old woman with diabetes, hypertension, and heart failure, who also had a history of CABG. She presented with worsening dyspnea, orthopnea, and edema. Imaging revealed occlusion of the circumflex artery graft and severe LSA stenosis. Successful stenting of the LSA alleviated her symptoms and restored normal blood flow from the LIMA graft. She was discharged after 2days and remains well at the six-month follow-up. CSSS should be considered in the differential diagnosis of patients with a history of CABG who present with angina or heart failure. Prompt treatment can lead to significant symptom improvement.

Multiple arterial grafting: are women being left behind?

Multiple arterial grafting: are women being left behind?

Injury to Internal Thoracic Artery to Left Anterior Descending Artery Grafts in Cardiac Reoperations

This case series examines experiences and outcomes associated cardiac reoperations with preexisting internal thoracic artery to left anterior descending artery grafts.

Vascular reconstructions in living donor kidney transplantation: a single-center experience over the last 17 years.

In living donor kidney transplantation (LDKT), vascular anastomosis is more difficult due to missing arterial patches and shorter renal veins. The surgical challenge is even more demanding in kidneys with multiple arteries. Although renal transplantation is feasible in most cases of complex donor vascular anatomy and similar results compared with standard LDKT are reported, the discussion on potentially increased complication rates and graft function continues. This prompted us to review our results of LDKT with multiple renal artery (MRA) grafts with a special concentration on complications and long-term function. We reviewed the records of all LDKT in our center from the beginning of the program in 2005 until 2022 for arterial vascular reconstructions. The cohort was divided into two groups: transplantation with vascular reconstruction (VR) and standard transplantation. These groups were compared for operative parameters and short- and long-term results. From 2005 to 2022, 211 LDKT were completed in our unit. In 32 (15.2%), a VR was performed, including single ostium side-to-side anastomosis, end-to-side anastomosis, patch reconstruction, and vein interposition. There was no significant difference in operative time (169 min vs. 180 min; p = 0.118) and time for anastomosis (28 min vs. 26 min; p = 0.59) between both groups. Postoperative complications (5.7% vs. 7.4%; p = 0.72) were not significantly different. During the follow-up period (110 months, range 10-204), the risk of organ loss was comparable after VR (13.625% vs. 11.56% p = 0.69). In LDKT, arterial vascular reconstructions for kidneys with MRA provide similar results compared to grafts with a single renal artery (SRA). Short- and long-term results are comparable with standard procedures.

Association of preoperative spirometry with postoperative pulmonary complications and prolonged length of hospital stay following coronary artery graft surgery

Association of preoperative spirometry with postoperative pulmonary complications and prolonged length of hospital stay following coronary artery graft surgery

Coronary Ostial Angioplasty for Takayasu Arteritis Using External Iliac Artery Graft: One-year Follow-Up

Coronary Ostial Angioplasty for Takayasu Arteritis Using External Iliac Artery Graft: One-year Follow-Up

Endovascular Embolization Through Grafts for Recurrent Giant Complex Internal Carotid Artery Aneurysms After Combined Microsurgical Low-Flow With Subsequent High-Flow Revascularization and Parent Artery Occlusion

BACKGROUND AND IMPORTANCE: The case describes the management of a giant and recurrent aneurysm in a patient. The treatment involved a combination of microsurgical protective low-flow, followed by high-flow revascularization and parent artery occlusion. CLINICAL PRESENTATION: The patient presented with severe headaches and progressive visual impairment. Brain magnetic resonance imaging revealed a giant saccular intracranial aneurysm in the left internal carotid artery. The examination also revealed hypoplasia of the right anterior cerebral artery and a fetal-type left posterior cerebral artery originating from the neck of the aneurysm. Considering the location and size of the aneurysm, a combination of endovascular and microsurgical approaches was applied. A protective low-flow procedure was followed by high-flow revascularization and occlusion of the parent artery. After 12 months, the aneurysm recanalized through the graft. To address the recurrence of giant complex aneurysms, endovascular embolization was performed through the radial artery grafts. These interventions showed positive midterm outcomes for the patient's giant aneurysm. CONCLUSION: In the treatment of complex giant aneurysms, it is important to consider both endovascular and microsurgical approaches as complementary, rather than mutually exclusive. Endovascular embolization using radial artery grafts may be used when dealing with retrograde recanalization and the challenges associated with accessing the aneurysm.

Intra-operative and post-operative management of conduits for coronary artery bypass grafting: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Surgery and the European Association for Cardio-Thoracic Surgery Coronary Task Force.

The structural and functional integrity of conduits used for coronary artery bypass grafting is critical for graft patency. Disruption of endothelial integrity and endothelial dysfunction are incurred during conduit harvesting subsequent to mechanical or thermal injury and during conduit storage prior to grafting, leading to acute thrombosis and early graft failure. Late graft failure, in particular that of vein grafts, is precipitated by progressive atherogenesis. Intra-operative management includes appropriate selection of conduit-specific harvesting techniques and storage solutions. Arterial grafts are prone to vasospasm subsequent to surgical manipulation, and application of intra-operative vasodilatory protocols is critical. Post-operative management includes continuation of oral vasodilator therapy and selection of antithrombotic and lipid-lowering agents to attenuate atherosclerotic disease progression in conduits. In this review, the scientific evidence underlying the key aspects of intra- and post-operative management of conduits for coronary artery bypass grafting is examined. Clinical consensus statements for best clinical practice are provided, and areas requiring further research are highlighted.

Coronary Artery Bypass Grafting Plus Mitral Valve Plasty May Not Provide More Advantage in Patients with Coronary Heart Disease and Moderate Ischemic Mitral Regurgitation: An Inverse Probability of Treatment Weighting Retrospective Cohort Study.

To compare the efficacy of isolated off-pump coronary artery bypass grafting (OPCABG) and of coronary artery bypass grafting (CABG) plus mitral valve plasty (MVP) in treating coronary heart disease with moderate ischemic mitral regurgitation to find a better surgical method. Clinical data of 822 patients diagnosed with coronary heart disease and moderate ischemic mitral regurgitation were analyzed retrospectively. Patients were divided into the OPCABG and CABG+MVP groups according to surgical methods. Baseline data of both groups were corrected, and clinical efficacy of the two surgical methods was analyzed and compared using the propensity score inverse probability of treatment weighting (IPTW) method. There were no significant differences in the use of mammary artery grafts, number of grafts, and blood product consumption between the two groups (P>0.05) after IPTW. However, the CABG+MVP group had a significantly longer operation time than the OPCABG group (4.13 ± 0.85 hours vs. 5.65 ± 1.02 hours, P<0.001). No statistically significant differences in postoperative major adverse cardiac and cerebrovascular events were observed between the two groups. However, the intra-aortic balloon pump rate was higher in the CABG+MVP group than in the OPCABG group (12.3% vs. 25.0%, P=0.012). Although CABG+MVP can improve ischemic mitral regurgitation significantly (95.4% vs. 81.2%, P<0.001), there were no significant differences in the cumulative survival rate and the incidence of major adverse cardiac and cerebrovascular events between the groups (P>0.05) after IPTW. CABG+MVP may not provide more advantage in patients with coronary heart disease and moderate ischemic mitral regurgitation.