scholarly journals Intraoperative Assessment of Coronary Resistances: A New Quality Marker and Potential Tool to Predict Early Graft Failure after Coronary Artery Bypass Grafting?

2021 ◽  
Vol 8 (12) ◽  
pp. 163
Author(s):  
Antonino Salvatore Rubino ◽  
Fabrizio Ceresa ◽  
Liborio Mammana ◽  
Giuseppe Vite ◽  
Gianluca Cullurà ◽  
...  
Keyword(s):  
Graft Failure ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Additional Tool ◽  
Intraoperative Assessment ◽  
Early Graft ◽  
Early Graft Failure

Intraoperative assessment of graft patency is pivotal for successful coronary revascularization. In the present study we aimed to propose a new, easy to perform tool to assess anastomotic quality intraoperatively, and to investigate its potential reliability in predicting early graft failure. Intraoperative graft flowmetry of 63 consecutive patients undergoing CABG were prospectively collected. Transit time flowmetry and its derivatives were recorded. Coronary resistances were calculated according to Hagen–Poiseuille equation both during cardioplegic arrest and after withdrawal from cardiopulmonary bypass. Angiographic evidence of graft occlusion at follow-up was cross-checked with intraoperative recordings. After a mean follow-up of 10.4 ± 6.0 months, 22 grafts were studied, and occlusion was documented in five (22.7%). Occluded grafts showed lower flows and higher resistances recorded during aortic cross-clamping. Coronary resistances, recorded during aortic cross-clamping, greater than 2.0 mmHg/mL/min, showed a sensitivity of 80% and a specificity of 100% to predict graft failure. We propose the routine recording of coronary resistances during aortic cross-clamping as an additional tool to overcome the acknowledged limitation of TTF to predict graft occlusion at 1 year.

Outcomes of Repair of Total Graft Detachment following Descemetʼs Membrane Endothelial Keratoplasty

2021 ◽  
Author(s):  
Avital Adler ◽  
Eliane Rozanes ◽  
Peter Ciechanowski ◽  
Yoav Nahum ◽  
Shmuel Graffi ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Graft Failure ◽  
Salvage Surgery ◽  
Endothelial Keratoplasty ◽  
Medical Centers ◽  
Early Graft ◽  
Secondary Operations ◽  
Early Graft Failure

Abstract Objective To present the outcomes of attempts to salvage total graft detachment following Descemetʼs membrane endothelial keratoplasty (DMEK). Methods A search of the electronic medical records of two tertiary medical centers for all patients who underwent DMEK yielded six cases of postoperative total graft detachment (2.54%). Graft salvage was attempted in all cases using repeated intracameral graft staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas. Results In all cases, a free-floating totally detached graft was identified in the anterior chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented, and fully attached graft. In three cases, the primary graft failed, and in two, the corneas cleared at first but failed after 2 months and 1 year respectively. In one case, the cornea remained clear during 1 year of follow-up but had a very low endothelial cell density. Conclusion Reattachment of fully detached DMEK graft is technically possible, but graft manipulation during the primary and secondary operations is likely to damage the endothelial cells, resulting in primary or early graft failure. If graft salvage is attempted, the probability of primary or early graft failure should be discussed with the patient, and expectations should be tempered accordingly.

scholarly journals Transit time flow measurement predicts graft patency in off-pump coronary artery bypass grafting upon 5-year angiographic follow-up

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Caiwu Zeng ◽  
Xiaomi Li ◽  
Yan Dai ◽  
Ye Zhou ◽  
Chenglong Li ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Graft Failure ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Patency ◽  
Bypass Grafts ◽  
Off Pump ◽  
Time Flow ◽  
Pump Coronary Artery Bypass

Abstract Objective This retrospective study sought to evaluate the efficacy of transit time flow measurement (TTFM) as a means of predicting bypass graft patency as assessed by coronary artery angiography upon 5-year follow-up. Methods Of 311 patients undergone isolated off-pump coronary artery bypass graft surgery from January 2014 through December 2014, 202 (65%) underwent both intraoperative TTFM and angiography at follow-up. 610 grafts, 202 left internal mammary artery grafts and 408 saphenous vein grafts were checked. Any grafts that exhibited Fitzgibbon type B or O lesions upon angiographic evaluation were considered to be failing. Receiver operating characteristic curves were used to identify the optimal TTFM values for predicting graft patency. Results A total of 610 grafts were included in this analysis, including 202 LIMA grafts and 408 SV grafts, of which 107, 129, 129, and 43 anastomosed to DIAG, OM, PDA, and PLA, respectively. LIMA, DIAG, OM, PDA, and PLA bypass grafts had overall patency rates of 95.0%, 74.8%, 73.6%, 71.5%, and 74.4%, respectively, upon 5-year follow up. No significant differences in TTFM values (MGF, PI, and DF) were observed when comparing outcomes associated with individual or sequential SV grafting. MGF was found to be predictive of graft failure regardless of the target vessel (P < 0.05). While PI was found to predict LIMA, OM, and PDA graft failure (P < 0.05), it was not associated with the failure of grafts associated with DIAG and PLA vessels. Similarly, DF was found to predict OM and PDA graft failure (P < 0.05), but was not significantly associated with the failure of grafts associated with LIMA, DIAG, or PLA vessels. Conclusion LIMA bypass grafts were associated with better 5-year graft patency relative to SV bypass grafts. Similar graft patency rates were observed for both individual and sequential bypass grafts. MGF was able to predict bypass graft failure in patients that underwent off-pump CABG surgery.

Abstract 16023: Network Meta-analysis of Randomized Controlled Trials for Graft Patency of a Second Conduit for Coronary Artery Bypass Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Coronary Artery ◽  
Graft Failure ◽  
Internal Thoracic Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Graft Patency ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Right

Background: It has been well documented that the use of the left internal thoracic artery (LITA) to graft the left anterior descending (LAD) artery has a significant benefit in coronary artery bypass graft (CABG) surgery. However, what graft is the best as a second conduit to complement LITA-LAD anastomosis remains uncertain. We thus conducted a network meta-analysis of RCTs to compare graft patency of the radial artery (RA), the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), and saphenous vein (SVG) as a second conduit in CABG. Methods: MEDLINE and EMBASE were searched through February 8th, 2020 to identify randomized controlled trials (RCTs) that investigated graft patency of a second conduit in CABG. From each study, we extracted the incidence rate ratios (IRR) of the outcome. Results: A total of 11 RCTs were identified, including 3,434 patients and 2,171 angiographic results. There was no significant difference of IRR in graft failure among the 4 groups (vs. SVG: RA, IRR [95%CI] =0.66 [0.41-1.07]; RGEA, IRR [95% CI] =2.12 [0.54-8.38]; RITA, IRR [95% CI] =0.71 [0.32-1.60]). (Figure) Sensitivity analyses restricting trials with ≥3 years angiographic follow-up time or ≥5 years angiographic follow-up time showed no significant differences of IRR in graft failure among the four groups in both analyses. Conclusion: In a network meta-analysis of the updated outcomes from RCTs, no significant differences were observed in graft patency with the use of RA, RITA, RGEA or SVG as a second conduit in CABG.

Early vein graft failure

2021 ◽  
pp. 227-232
Author(s):  
Alexios S. Antonopoulos ◽  
Charalambos Antoniades
Keyword(s):  
Coronary Artery ◽  
Graft Failure ◽  
Artery Bypass ◽  
Clinical Effectiveness ◽  
Graft Occlusion ◽  
Post Surgery ◽  
Extracellular Matrix Remodelling ◽  
Early Graft ◽  
Artery Disease ◽  
Vein Graft Failure

Coronary artery bypass grafting is a revascularization strategy that improves the clinical outcome of patients with coronary artery disease, but its clinical effectiveness may be hampered by graft occlusion. The mechanisms of graft failure are complex and multifactorial. Graft failure is defined as acute (<1 month), early (1–12 months), and late (>12 months) post surgery and the mechanisms are usually discreet. Graft manipulation and vein biology post engraftment may affect the risk of early acute graft failure. Activation of smooth muscle cell and adventitial fibroblasts, triggered also by the adaptation of the vein to arterial conditions, are involved in extracellular matrix remodelling and intimal hyperplasia development. Graft atherosclerosis can also result in late graft failure. This chapter summarizes the mechanisms of graft failure, provides an overview of the magnitude of the problem of early graft failure, and discusses potential therapeutic strategies.

scholarly journals Does Early Graft Patency Benefit from Perioperative Statin Therapy? A Propensity Score-Matched Study of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Shanglin Chen ◽  
Hengchao Wu ◽  
Tao Yang ◽  
Baotong Li ◽  
Yuanyu Hu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Statin Therapy ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Graft Patency ◽  
Graft Occlusion ◽  
Off Pump ◽  
Early Graft ◽  
Secondary Outcomes ◽  
Pump Coronary Artery Bypass

Background. Decreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations. Methods. 582 patients undergoing OPCAB in a single-institution database (October 1, 2009–September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions. Results. No in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026). Conclusions. Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT 01268917).

Role of Coronary Graft Flow Measurement During Reoperations for Early Graft Failure After Off-Pump Coronary Revascularization

1999 ◽  
Vol 14 (5) ◽  
pp. 342-347 ◽  
Author(s):  
Marco Ricci ◽  
Hratch L. Karamanoukian ◽  
Tomas A. Salerno ◽  
Giuseppe D'Ancona ◽  
Jacob Bergsland
Keyword(s):  
Graft Failure ◽  
Flow Measurement ◽  
Coronary Revascularization ◽  
Off Pump ◽  
Graft Flow ◽  
Early Graft ◽  
Early Graft Failure

Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery

Perfusion ◽  
2021 ◽  
pp. 026765912098881
Author(s):  
Haitao Li ◽  
Liangshan Wang ◽  
Changcheng Liu ◽  
Chengxiong Gu
Keyword(s):  
Graft Failure ◽  
Cox Regression ◽  
Artery Bypass ◽  
Graft Patency ◽  
Distal Anastomosis ◽  
Perioperative Outcomes ◽  
Cox Regression Analysis ◽  
Severe Lesion ◽  
Significant Difference

Background: The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency. Methods: Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, n = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, n = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG. Results: There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842–60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453–9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081–0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139–0.812, p = 0.015) were significant protective factors. Conclusions: Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.

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