scholarly journals Multiple Skin Bridging for No-Touch Saphenous-Vein Grafts Harvesting Can Reduce Wound Morbidity

2021 ◽  
Vol 24 (3) ◽  
pp. E496-E501
Author(s):  
Kang Zhou ◽  
Xiaoke Qi ◽  
Shijie Wei ◽  
Xinmin Zhou ◽  
Yuan Zhao
Keyword(s):  
Saphenous Vein ◽  
Patency Rate ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Subjective Perception ◽  
Significant Difference ◽  
One Year ◽  
Bridging Technique ◽  
Graft Length

Background: Reducing the leg wound morbidity is crucial for the patients undergoing coronary artery bypass grafting (CABG) with great saphenous vein (SV) grafts harvested by no-touch (NT) technique. This study was to summarize the experience of skin bridging technique for reducing wound morbidity and the influence of it on one-year bypass graft patency. Methods: According to skin bridging or not, harvesting times, graft length, number of bleeding branches, postoperative subjective perception assessment scale (ASEPSIS) scores and one-year patency rate were analyzed. Results: From June 2018 to February 2019, 60 patients underwent CABG with SV grafts either with open-incision NT or skin bridging NT (30 in each group). There were no significant differences in age (71.4 ± 5.1 years vs. 68.9 ± 5.5 years) or graft length (23.3 ± 1.1 cm vs. 23.9 ± 1.3 cm) between the two groups. The bridging/NT group had a significantly longer harvest time (38.5 ± 4.9 min vs. 18.5 ± 2.6 min; P < 0.001) and a significantly greater number of bleeding branches (1.9 ± 1.2 vs. 0.8 ± 0.8; P < 0.001) than the open NT group. The open NT group had a significantly higher ASEPSIS score (23.8 ± 2.0 vs. 15.7 ± 2.6; P < 0.001). There was no significant difference in patency rate at one-year follow-up. Conclusion: Obtaining the SV by the combined NT/discontinuous skin bridging technique is a satisfactory method for patients who underwent CABG. This method has important clinical significance in reducing wound morbidity in the harvest of NT grafts.

Protamine sulfate use during tibial bypass does not appear to increase thrombotic events or affect short-term graft patency

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 708-714
Author(s):  
John Phair ◽  
John Futchko ◽  
Eric B Trestman ◽  
Matthew Carnevale ◽  
Patricia Friedmann ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Limb Ischemia ◽  
Graft Patency ◽  
Protamine Sulfate ◽  
Bypass Grafting ◽  
Bleeding Events ◽  
Reversal Agent ◽  
Increased Risk ◽  
Significant Difference

Objectives While the use of protamine sulfate as a heparin reversal agent has been extensively reviewed in patients undergoing carotid endarterectomy and coronary artery bypass grafting, there is a lack of literature on protamine’s effects on lower extremity bypasses. The purpose of this study was to determine the risk of protamine sulfate dosing after tibial bypass on thrombotic or bleeding events, including early bypass failure. Methods We performed a retrospective review of our institutional database for patients undergoing primary distal peripheral bypass from January 2009 through December 2015 (contralateral bypass was considered to be a new primary bypass). Primary endpoints include composite thrombotic events (myocardial infarction, stroke, amputation at 30 days and patency less than 30 days) and composite bleeding events (bleeding or transfusion). Results A total of 152 tibial or peroneal bypasses in 136 patients with critical limb ischemia were identified. Of these, 78 (57.4%) patients received protamine sulfate intraoperatively and 58 (42.6%) did not. There were no differences in composite thrombotic or hemorrhagic outcomes. Protamine use had no effect on the rates of perioperative MI (9.0% versus 3.5%, p = 0.20), stroke (1.3% versus 1.7%, p = 0.83), or perioperative mortality (5.1% versus 3.5%, p = 0.64). There was no significant difference in composite post-operative bleeding events (20.7% versus 14.1%, p = 0.31) or composite thrombotic events (17.2% versus 18.0%, p = 0.91). Patients who received protamine undergoing bypass with non-autogenous conduit had significantly higher-recorded median operative blood loss (250 mL versus 150 mL, p = 0.0097) and median procedure lengths (265 min versus 201 min, p = 0.0229). No difference in 30-day amputation-free survival was noted (91.0% versus 91.4%, p = 0.94). Follow-up Kaplan–Meier estimation did not demonstrate a difference in 30-day patency (91.7% versus 88.5%, p = 0.52). Conclusions Heparin reversal with protamine sulfate after tibial or peroneal bypass grafting is not associated with higher cardiovascular morbidity, bypass thrombosis, amputation, or mortality. Additionally, there was no statistically significant difference in post-operative bleeding or thrombosis complications for patients who did not receive protamine, although the findings are suggestive of a potential difference in a more adequately powered study. Our results suggest that protamine sulfate is safe for intraoperative use without increased risk of thrombotic complications or early tibial bypass graft failure.

Effect of Proximal Anastomotic Diameter on Venous Bypass Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting

2015 ◽  
Vol 18 (5) ◽  
pp. 201
Author(s):  
Mehmet Kaya ◽  
Taner İyigün ◽  
Mugisha Kyaruzi ◽  
Okan Akıncı ◽  
Hafize Otcu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Graft Failure ◽  
Protective Factor ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Proximal Anastomosis ◽  
Cox Regression Analysis ◽  
Significant Difference

<strong>Background:</strong> In this study, the relationship between patency of saphenous vein (SV) graft and different sizes of aorta wall punches was investigated during the follow-up period after coronary artery bypass graft surgery. We also evaluated the other possible factors affecting SV graft patency.<br /><strong>Methods:</strong> This study consisted of 266 consecutive and symptomatic patients with postoperative angiography. The primary endpoint was at least one saphenous graft failure observed from coronary computed tomography angiography (cCTA) and/or invasive angiography after surgery. Groups were created as SV occluded and patent group. Survival curves of patients in groups were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazard model.<br /><strong>Results:</strong> Cox-regression analysis demonstrated influence of older age (P = .023) and Diabetes Mellitus (DM) (P = .002) on SV graft failure. However, increasing ejection fraction (P = .011) was a protective factor against SV graft failure. There was no significant difference between the two groups in terms of usage rate of the punches with different diameters (P = .296).<br /><strong>Conclusion:</strong> The incidence of SV graft patency does not seem to increase in patients whose 4.8-mm aortic punch was used during proximal anastomosis compared to the reference group in which a punch of 4.0 mm was used. Also, the final proximal anastomosis graft size that was measured using cCTA was similar between patients with 4.8-mm punch and patients with 4-mm punch. Results from this study could help to determine which size for aortosaphenous anastomosis is clinically optimal.

scholarly journals Graft Patency Rate and Risk Factors for Graft Failure among Symptomatic Post Coronary Artery Bypass Graft Surgery Patients

2020 ◽  
Vol 28 (1) ◽  
pp. 32-37
Author(s):  
Woan Shiang See ◽  
Syed Rasul Bin Ghouse Syed Hamid ◽  
Cheang Leng Benjamin Leo ◽  
Kian Boon Law
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Patency Rate ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Rank Test ◽  
Conventional Coronary Angiography ◽  
P Value ◽  
Cabg Patients

BACKGROUND Malaysia, a multiracial country, has been burdened by ischemic heart disease, the leading cause of death for the past 10 years. The success of coronary artery bypass grafting surgery (CABG) particularly depends on the continued patency of aortocoronary grafts. The study aims to identify the graft patency rate and risk factors of graft failure among symptomatic post CABG patients. METHODS Data were collected from 80 patients with a history of CABG, who underwent conventional coronary angiography for refractory angina in Hospital Sultanah Aminah Johor, Malaysia from January 2014 till December 2018. The graft patency was evaluated with conventional coronary angiography. Graft patency was assessed with the Kaplan-Meier method. Differences between graft patency were tested with log-rank test at a 5% significance level and result with p-value <0.05 was considered statistically significant. RESULTS Among the 80 post CABG patients with cardiac symptoms, there were 2 patients with acute myocardial infarction (2.5%) and 24 patients with NSTEMI (30%). 22 patients (27.5%) were found to have all grafts patent despite being persistently symptomatic. Left internal mammary arterial (LIMA) graft remained as the best conduit with a significantly better short, medium, and long term patency (up to 20 years) compared to SVG graft (Log-rank test, p-value < 0.05). Indian race and age less than 70 years had higher risk of SVG graft stenosis. CONCLUSION Type of conduits remains the most important factor in determining the coronary artery bypass graft patency, with LIMA produces the best patency rate in both short and long term.

scholarly journals A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models

2020 ◽  
Vol 23 (2) ◽  
pp. E135-E139
Author(s):  
Hakan Gocer ◽  
Ahmet Baris Durukan ◽  
Osman Tunc ◽  
Erdinc Naseri ◽  
Ertugrul Ercan
Keyword(s):  
3D Printing ◽  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Coronary Revascularization ◽  
Operation Time ◽  
Graft Patency ◽  
3D Print ◽  
Vein Grafts ◽  
Significant Difference ◽  
Graft Length

Background: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length. Methods: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared. Results: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05). Conclusion: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites. INTRODUCTION

2223Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on vein-graft patency 1 year after coronary artery bypass grafting with or without diabetes: a post-hoc analysis of the DACAB tria

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y P Zhu ◽  
H Liu ◽  
M L Zhang ◽  
J Mei ◽  
Q Zhao
Keyword(s):  
Coronary Artery ◽  
Vein Graft ◽  
Patency Rate ◽  
Artery Bypass ◽  
Graft Patency ◽  
Bypass Grafting ◽  
Once Daily ◽  
Vein Grafts ◽  
Significant Difference ◽  
Graft Patency Rate

Abstract Introduction The association of diabetes and vein graft patency after coronary artery bypass grafting (CABG) remains controversial. In patients with diabetes, impaired endothelial function in vein grafts and high platelet turnover might result in early vein graft failure. The DACAB trial showed ticagrelor plus aspirin significantly increased 1-year vein graft patency vs. aspirin alone, while no significant difference between ticagrelor alone and aspirin alone. However, whether the results is different between the patients with or without diabetes is unknown. Purpose To assess the effects of ticagrelor with or without aspirin vs. aspirin alone on 1-year vein grafts patency after CABG in patients with or without diabetes. Methods We examined the subgroups of patients with and without diabetes from DACAB trial (NCT02201771), in which 500 patients were randomized to 1 of 3 antiplatelet regimens (ticagrelor 90mg twice daily plus aspirin 100mg once daily, T+A group; ticagrelor 90mg twice daily, T group; or aspirin 100mg once daily, A group) within 24 hours post-CABG. The primary outcome was 1-year vein graft patency (FitzGibbon grade A) assessed by multi-slice computed tomographic angiography or coronary angiography. Results According to the baseline medical history and/or glycated hemoglobin (HbA1c) ≥6.5%, 283 patients with 818 vein grafts were allocated to the non-diabetes subgroup, remaining 217 patients with 642 vein grafts to the diabetes subgroup. By per-graft analysis, no significant difference on 1-year vein graft patency rate was observed between non-diabetes and diabetes subgroup (84.6% [692/881] for non-diabetes vs. 80.2% [515/642] for diabetes, adjusted odds ratio (OR) =1.39, 95% CI: 0.92–2.09, P=0.116). In T+A group, 1-year vein graft patency rates were 91.0% (244/268) for non-diabetes vs. 85.8% (188/219) for diabetes; In T group, 85.0% (221/260) for non-diabetes vs. 80.3% (183/228) for diabetes; In A group, 78.3% (227/290) for non-diabetes vs. 73.9% (144/195) for diabetes. Ticagrelor plus aspirin showed higher vein graft patency rate than aspirin alone in both non-diabetes and diabetes subgroup (non-diabetes: adjusted OR = 0.34, 95% CI: 0.17–0.69, and diabetes: adjusted OR = 0.42, 95% CI: 0.19–0.91, P for interaction = 0.524), whereas ticagrelor alone did not show improvement on vein graft patency compared with aspirin alone in both subgroups (non-diabetes: adjusted OR=0.62, 95% CI: 0.32–1.20, and diabetes: adjusted OR = 0.65, 95% CI: 0.33–1.31, P for interaction = 0.795). Similar results were showed by per-patient analysis. A total 16 major adverse cardiovascular events occurred, 8 (2.8%) for non-diabetes and 8 (3.7%) for diabetes. Conclusion In the DACAB trial, diabetes was not found to be associated with decreased vein graft patency at 1 year after CABG. The effect of ticagrelor plus aspirin on improvement of 1-year vein graft patency, when compared with aspirin alone, is consistent in patients with or without diabetes. Acknowledgement/Funding AstraZeneca

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