Individual versus Sequential Saphenous Vein Grafts for On-pump Coronary Artery Bypass Grafting – Does Smaller Coronaries in Indians Affect Graft Choice? - A Mid-Term Patency Comparison
Manoj Murlidhar JoshiSaptarshi PaulKrishnarao Narayan BhosleSuraj Wasudeo NagreHrishikesh Sukhadeo ParashiManish JadhaoKunal Hemant RawekarVignesh RavikumarVishal SawkarJoshua Anish S. Selwyn
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Abstract:
Although multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG's.Keywords:
Saphenous vein graft
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Great saphenous vein
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Abstract Reoperations for coronary artery bypass grafting (CABG) are increasing. The general rule of replacing all saphenous vein grafts older than five years of age at the time of reoperation is still an object of discussion. We report here the clinical usefulness of the new 128-slice computed tomographic scan to detect or rule out coronary artery disease in a 79-year-old patient who had undergone CABG 22 years before.
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Coronary artery disease remains a global health concern and the leading cause of death. Till today, coronary artery bypass grafting (CABG) is one of the main treatment strategies for coronary artery disease, especially for Multivessel coronary disease or complex coronary lesions. The present study aimed to explore the relationship of preoperative albumin corrected anion gap (ACAG) with mortality in all those patients who undergoing CABG.All the patients undergoing CABG were included in the study. All clinical data were collected from CareVue and MetaVision system. The predictive value of ACAG for mortality was determined by receiver operating characteristic (ROC) curves survival curves were estimated using the Kaplan-Meier method. Multivariate regression models were constructed to determine the association of ACAG with mortality.A total of 2,180 patients were identified and divided into a high ACAG group (ACAG ≥16.0 mmol/L) and low ACAG group (ACAG <16.0 mmol/L) according to the ROC analysis. Patients in the high ACAG group were older and presented with more comorbidities and concomitant valvular surgeries. Further more, in the high ACAG group, we observed a higher length of stay in the intensive care unit [3.88 (2.15, 7.09) vs. 2.29 (1.29, 3.94), P<0.001]. Both the in-hospital mortality [28 (4.5%) vs. 11 (0.7%), P<0.001], and the 4-year mortality [125 (27.1%) vs. 111 (12.7%), P<0.001] were also rised in those patients. And it was also showed in the survival curves, patients with ACAG ≥16.0 mmol/L had a significant lower 4-year survival (P<0.001). While in the multivariate regression model, we found ACAG was act as an independent risk factor for both the in-hospital mortality [odds ratio (OR): 1.248 (1.060, 1.470), P=0.008] and the 4-year mortality [hazard ratio (HR): 1.134 (1.063, 1.210), P<0.001]. An ACAG ≥16.0 mmol/L was significantly associated with a 2.7-fold risk of in-hospital mortality [OR: 2.732 (1.129, 6.610), P=0.026].Preoperative ACAG is an independent risk factor for in-hospital and long-term mortality in CABG patients. A higher ACAG may relate to severe coronary artery stenosis and cardiac dysfunction, which is more likely to lead to a postoperative systemic inflammatory response, microcirculation disorder, and subsequent complications.
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A self-limited rupture of a five month old saphenous vein bypass graft occurred during coronary angioplasty when the balloon used to stretch the vessel proved to be too large. A lack of fibrous tissue in the new graft may have predisposed it to rupture.
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The internal mammary artery is the premier conduit for initial and repeat coronary artery bypass grafting and should be used as either a pedicled or free graft whenever possible. Saphenous veins from the greater and lesser systems are distinctly second choices but can serve satisfactorily as aortocoronary grafts for many years. When neither the internal mammary arteries nor the saphenous veins are available, the cardiac surgeon today must choose from a wide variety of alternative conduits that have been used periodically over the past two decades for coronary artery bypass grafting.
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Aneurysmal dilatation in a venous graft following coronary artery bypass grafting (CABG) is extremely rare. Recently, we performed a resection of aneurysm and redo CABG in two patients who developed aneurysmal changes in the graft, one after 1 year and 10 months and the other after 3 years and 11 months, and obtained good results.
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