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

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.

Stress testing-guided assessment of coronary artery bypass grafts patency, at 6 months of follow up. A prospective study

Purpose: To assess the coronary bypass grafts patency and the repeat revascularization rate, six months after coronary artery bypass grafting (CABG). Methods: We prospectively enrolled 145 consecutive patients undergoing isolated CABG between June 2014 and June 2016. We performed at 6 months of follow up a coronary computed tomography angiography (CTA) in patients whose stress tests were negative and an invasive coronary angiography (ICA) in the opposite case. Results: A total of 134 CTA and 11 ICA were performed, allowing the analysis of 321 grafts, including 143 left internal thoracic arteries (LITA), 89 right internal thoracic arteries (RITA) and 89 saphenous veins grafts (SVG). The average graft patency was 95.1% for LITA, 84.3% for RITA and 64% for SVG. The best patencies were obtained when these grafts were anastomosed to the left anterior descending artery (LAD): 96.3% for LITA, and 87.5% for RITA. SVG patency was homogeneous whether between the main right coronary artery and its branches (63.4% versus 65% respectively. p = 1), or between circumflex and RCA (72.7% versus. 63.9% respectively. p=0.6). On the right and circumflex coronary arteries, the patency of the SVG was significantly lower than that of RITA (66.26% versus 83.95% respectively, p = 0.011). At 6 months of follow up, the repeat revascularization rate was 2.07% (n=3/145). Conclusions: 6 months after CABG, RITA and LITA had good patencies especially on LAD, while SVG was occluded in almost a third of cases. On the circumflex and right coronary arteries, SVG patency was significantly lower than that of RITA. Keywords: Coronary Artery Bypass; Exercise Testing; Coronary Angiography; Computed Tomography Angiograph

Unprotected Left Main is now no more Domain of Surgeon

Unprotected Left Main Coronary Artery (ULMCA) disease is defined as significant stenosis in the Left Main Coronary Artery (LMCA) and there were no previous Coronary artery bypass surgery (CABG) or patent bypass grafts to the left anterior descending (LAD) or left circumflex (LCX) arteries

An original method of pericardium closure after coronary artery bypass grafting

<p>Different cardiac surgery centres have different views regarding pericardial suturing. However, there is limited scientific evidence confirming the advantage of one method over another, which disallows us from forming a general opinion regarding specialists. Here, we describe several well-known methods of suturing the pericardium and preventing traumatisation of coronary bypass grafts and analyse their weaknesses. An original technique of opening and suturing the pericardium is proposed to restore the physiological distinction between the pericardial cavity and the anterior mediastinum during coronary artery bypass grafting without the risk of compromising the functioning coronary bypass grafts and narrow mediastinal syndrome.<br />The proposed method of suturing the pericardium received a patent for invention, No. 2733505, dated 2 October, 2020. In the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery (Moscow, Russian Federation), this technique of suturing the pericardium has been routinely used since 2006. More than 2,000 intraoperative shunt scans have been performed in our department since 2009; all these scans were performed after the pericardium was closed, proving that the fear of compromising the shunts during pericardial suturing is unsupported.</p><p>Received 17 December 2020. Revised 13 January 2021. Accepted 18 January 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: G.G. Kvaratskheliya, E.P. Golubev<br />Data collection and analysis: U.S. Avkhadov, R.M. Ibragimov<br />Drafting the article: G.G. Kvaratskheliya, E.P. Golubev<br />Critical revision of the article: E.U. Asymbekova, B.E. Rustamov, L.S. Shakhnazaryan, Yu.I. Buziashvili<br />Final approval of the version to be published: G.G. Kvaratskheliya, E.P. Golubev, U.S. Avkhadov, R.M. Ibragimov, B.E. Rustamov, E.U. Asymbekova, L.S. Shakhnazaryan, Yu.I. Buziashvili</p><p> </p>

Saphenous vein valve assessment utilizing upright CT to potentially improve graft assessment for bypass surgery

Saphenous veins (SVs) are frequently employed as bypass grafts. The SV graft failure is predominantly seen at the valve site. Avoiding valves during vein harvest would help reduce graft failure. We endeavored to detect SV valves, tributaries, and vessel size employing upright computed tomography (CT) for the raw cadaver venous samples and in healthy volunteers. Five cadaver legs were scanned. Anatomical analysis showed 3.0 (IQR: 2.0–3.0) valves and 13.50 (IQR: 10.00–16.25) tributaries. The upright CT completely detected, compared to 2.0 (IQR: 1.5–2.5, p = 0.06) valves and 9.5 (IQR: 7.5–13.0, p = 0.13) tributaries by supine CT. From a total of 190 volunteers, 138 (men:75, women:63) were included. The number of valves from the SF junction to 35 cm were significantly higher in upright CT than in supine CT bilaterally [upright vs. supine, Right: 4 (IQR: 3–5) vs. 2 (IQR:1–2), p < 0.0001, Left: 4 (IQR: 3–5) vs. 2 (IQR: 1–2), p < 0.0001]. The number of tributaries and vessel areas per leg were also higher for upright compared with supine CT. Upright CT enables non-invasive detection of SV valves, tributaries, and vessel size. Although not tested here, it is expected that upright CT may potentially improve graft assessment for bypass surgery.