Choice of conduit for coronary artery bypass grafting: technical, anatomic, and pharmacologic considerations

Lamia Harik , Kevin R. An , Arnaldo Dimagli , Roberto Perezgrovas-Olaria , Giovanni Jr Soletti , Jordan Leith , Michele Dell'Aquila , Camilla Rossi , Gianmarco Cancelli , Mario Gaudino

Vessel Plus ›› 2023, Vol. 7 ›› Issue (1) : 30

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Vessel Plus ›› 2023, Vol. 7 ›› Issue (1) :30 DOI: 10.20517/2574-1209.2023.124
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Choice of conduit for coronary artery bypass grafting: technical, anatomic, and pharmacologic considerations

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Abstract

The choice of graft used to bypass stenoses in the coronary circulation is crucial to coronary artery bypass grafting (CABG) surgery and its success. Herein is a review of the existing literature on CABG grafts, including the discussion of utilization of different CABG grafts, patency of different grafts, and technical and other considerations pertinent to the use of each graft. Lastly, we present special considerations for graft selection in women.

Keywords

Coronary artery bypass grafting / graft selection / conduit selection

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Lamia Harik, Kevin R. An, Arnaldo Dimagli, Roberto Perezgrovas-Olaria, Giovanni Jr Soletti, Jordan Leith, Michele Dell'Aquila, Camilla Rossi, Gianmarco Cancelli, Mario Gaudino. Choice of conduit for coronary artery bypass grafting: technical, anatomic, and pharmacologic considerations. Vessel Plus, 2023, 7(1): 30 DOI:10.20517/2574-1209.2023.124

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References

[1]

Harik L,Gaudino M.Unanswered questions on coronary artery graft patency and clinical outcomes.Curr Opin Cardiol2023;38:441-6

[2]

Gaudino M,Benedetto U.Mechanisms, consequences, and prevention of coronary graft failure.Circulation2017;136:1749-64

[3]

Lawton JS,Bangalore S.2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines.Circulation2022;145:e4-17

[4]

Neumann FJ,Ahlsson A.2018 ESC/EACTS Guidelines on myocardial revascularization.Eur Heart J2019;40:87-165

[5]

Chan J,Dong T,Sinha S.Trend and factors associated with multiple arterial revascularization in coronary artery bypass grafting in the UK.Eur J Cardiothorac Surg2022;62:ezac284

[6]

Schwann TA,Wallace A.Operative outcomes of multiple-arterial versus single-arterial coronary bypass grafting.Ann Thorac Surg2018;105:1109-19

[7]

Taggart DP,Gray AM.Randomized trial of bilateral versus single internal-thoracic-artery grafts.N Engl J Med2016;375:2540-9

[8]

Lazar HL.The risk of mediastinitis and deep sternal wound infections with single and bilateral, pedicled and skeletonized internal thoracic arteries.Ann Cardiothorac Surg2018;7:663-72 PMCID:PMC6219948

[9]

Caliskan E,Böning A.Saphenous vein grafts in contemporary coronary artery bypass graft surgery.Nat Rev Cardiol2020;17:155-69

[10]

Dimagli A,Harik L.Angiographic outcomes for arterial and venous conduits used in CABG.J Clin Med2023;12:2022 PMCID:PMC10004690

[11]

Gaudino M,Fremes SE.Angiographic outcome of coronary artery bypass grafts: the radial artery database international alliance.Ann Thorac Surg2020;109:688-94

[12]

Deng MX,Lee G.Angiographic patency of coronary artery bypass conduits: an updated network meta-analysis of randomized trials.Braz J Cardiovasc Surg2022;37:7-31 PMCID:PMC9454285

[13]

Buxton BF,Raman J.Long-term results of the RAPCO trials.Circulation2020;142:1330-8

[14]

Gaudino M,Bhatt DL.The association between coronary graft patency and clinical status in patients with coronary artery disease.Eur Heart J2021;42:1433-41 PMCID:PMC8861263

[15]

Gaudino M,An KR.Graft failure after coronary artery bypass grafting and its association with patient characteristics and clinical events: a pooled individual patient data analysis of clinical trials with imaging follow-up.Circulation2023;148:1305-15

[16]

Glineur D,Etienne PY.Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial.Eur Heart J2019;40:2421-8

[17]

Harskamp RE,Ferguson TB Jr.Frequency and predictors of internal mammary artery graft failure and subsequent clinical outcomes: insights from the project of ex-vivo vein graft engineering via transfection (PREVENT) IV trial.Circulation2016;133:131-8

[18]

Hamilton GW,Moten S.Radial artery vs. internal thoracic artery or saphenous vein grafts: 15-year results of the RAPCO trials.Eur Heart J2023;44:2406-8

[19]

Gaudino M,Fremes S.Association of radial artery graft vs saphenous vein graft with long-term cardiovascular outcomes among patients undergoing coronary artery bypass grafting: a systematic review and meta-analysis.JAMA2020;324:179-87 PMCID:PMC7361649

[20]

Taggart DP,Gerry S.Bilateral versus single internal-thoracic-artery grafts at 10 years.N Engl J Med2019;380:437-46

[21]

Harskamp RE,Baisden CE,Alexander JH.Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions.Ann Surg2013;257:824-33

[22]

Angelini GD,Breckenridge IM.Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery bypass grafts.Cardiovasc Res1987;21:902-7

[23]

Souza D.A new no-touch preparation technique. Technical notes.Scand J Thorac Cardiovasc Surg1996;30:41-4

[24]

Souza DS,Bojö L.Harvesting the saphenous vein with surrounding tissue for CABG provides long-term graft patency comparable to the left internal thoracic artery: results of a randomized longitudinal trial.J Thorac Cardiovasc Surg2006;132:373-8

[25]

Souza DS,Tsui JC.Improved patency in vein grafts harvested with surrounding tissue: results of a randomized study using three harvesting techniques.Ann Thorac Surg2002;73:1189-95

[26]

Deb S,de Souza D.SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449).J Cardiothorac Surg2019;14:85 PMCID:PMC6498551

[27]

Tian M,Sun H.No-touch versus conventional vein harvesting techniques at 12 months after coronary artery bypass grafting surgery: multicenter randomized, controlled trial.Circulation2021;144:1120-9

[28]

Ragnarsson S,Modrau IS.No-touch saphenous vein grafts in coronary artery surgery (SWEDEGRAFT): rationale and design of a multicenter, prospective, registry-based randomized clinical trial.Am Heart J2020;224:17-24

[29]

Davis Z,Zhang M,Castellanos Y.Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes.J Thorac Cardiovasc Surg1998;116:228-35

[30]

Li G,Wu Z,Zheng J.Mid-term and long-term outcomes of endoscopic versus open vein harvesting for coronary artery bypass: a systematic review and meta-analysis.Int J Surg2019;72:167-73

[31]

Deppe AC,Choi YH.Endoscopic vein harvesting for coronary artery bypass grafting: a systematic review with meta-analysis of 27,789 patients.J Surg Res2013;180:114-24

[32]

Kodia K,Weber MP.Graft patency after open versus endoscopic saphenous vein harvest in coronary artery bypass grafting surgery: a systematic review and meta-analysis.Ann Cardiothorac Surg2018;7:586-97 PMCID:PMC6219959

[33]

Woodward LC,Taggart DP.Intraoperative vein graft preservation: what is the solution?.Ann Thorac Surg2016;102:1736-46

[34]

Harik L,Soletti G Jr.Graft thrombosis after coronary artery bypass surgery and current practice for prevention.Front Cardiovasc Med2023;10:1125126 PMCID:PMC10031065

[35]

Motwani JG.Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention.Circulation1998;97:916-31

[36]

Wan S,Chan MC.Differential, time-dependent effects of perivenous application of fibrin glue on medial thickening in porcine saphenous vein grafts.Eur J Cardiothorac Surg2006;29:742-6

[37]

Schoettler J,Grothusen C.Highly flexible nitinol mesh to encase aortocoronary saphenous vein grafts: first clinical experiences and angiographic results nine months postoperatively.Interact Cardiovasc Thorac Surg2011;13:396-400

[38]

Murphy GJ,Jeremy JY,Angelini GD.A randomized trial of an external Dacron sheath for the prevention of vein graft disease: the extent study.J Thorac Cardiovasc Surg2007;134:504-5

[39]

Taggart DP,Lees B.A randomized trial of external stenting for saphenous vein grafts in coronary artery bypass grafting.Ann Thorac Surg2015;99:2039-45

[40]

Taggart DP,Desouza A.Long-term performance of an external stent for saphenous vein grafts: the VEST IV trial.J Cardiothorac Surg2018;13:117 PMCID:PMC6245530

[41]

Taggart DP,Djordjevic J.A prospective study of external stenting of saphenous vein grafts to the right coronary artery: the VEST II study.Eur J Cardiothorac Surg2017;51:952-8

[42]

Taggart DP,Krasopoulos G.External stenting and disease progression in saphenous vein grafts two years after coronary artery bypass grafting: a multicenter randomized trial.J Thorac Cardiovasc Surg2022;164:1532-41.e2

[43]

Park SJ,Kim JB.Sequential versus individual saphenous vein grafting during coronary arterial bypass surgery.Ann Thorac Surg2020;109:1165-73

[44]

Mehta RH,Lopes RD.Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of ex-vivo vein graft engineering via transfection (PREVENT) IV trial.Circulation2011;124:280-8

[45]

Xenogiannis I,Bhatt DL.Saphenous vein graft failure: from pathophysiology to prevention and treatment strategies.Circulation2021;144:728-45

[46]

Goldman S,Moritz T.Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a department of veterans affairs cooperative study.J Am Coll Cardiol2004;44:2149-56

[47]

Lorenz RL,Kotzur J.Improved aortocoronary bypass patency by low-dose aspirin (100 mg daily). Effects on platelet aggregation and thromboxane formation.Lancet1984;323:1261-4

[48]

Kulik A,Boronat V,Ruel M.Ticagrelor versus aspirin and vein graft patency after coronary bypass: a randomized trial.J Card Surg2022;37:563-70

[49]

Kulik A,Boronat V,Ruel M.Ticagrelor versus aspirin 2 years after coronary bypass: observational analysis from the TARGET trial.J Card Surg2022;37:1969-77

[50]

Sandner S,Angiolillo DJ.Association of dual antiplatelet therapy with ticagrelor with vein graft failure after coronary artery bypass graft surgery: a systematic review and meta-analysis.JAMA2022;328:554-62

[51]

Solo K,Kabali C.Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis.BMJ2019;367:l5476 PMCID:PMC6785742

[52]

Lamy A,Sheth T.Skeletonized vs pedicled internal mammary artery graft harvesting in coronary artery bypass surgery: a post hoc analysis from the COMPASS trial.JAMA Cardiol2021;6:1042-9

[53]

Gaudino M,Rahouma M.Comparison of long-term clinical outcomes of skeletonized vs pedicled internal thoracic artery harvesting techniques in the arterial revascularization trial.JAMA Cardiol2021;6:1380-6

[54]

Robinson BM,Naidoo R,Denniss AR.Bilateral internal thoracic artery composite Y grafts: analysis of 464 angiograms in 296 patients.Ann Thorac Surg2016;101:974-80

[55]

Bakay C,Korkmaz AA,Özkara A.Sequential in situ left internal thoracic artery grafting to the circumflex and right coronary artery areas.Ann Thorac Surg2013;95:63-70

[56]

Ohira S,Okawa K.Safety and efficacy of sequential left internal thoracic artery grafting to left circumflex area.Ann Thorac Surg2016;102:766-73

[57]

Ji Q,Xia L.Revascularization of left coronary system using a skeletonized left internal mammary artery - sequential vs. separate grafting.Circ J2017;82:102-9

[58]

Glineur D,Grau JB.FFR cutoff by arterial graft configuration and location: IMPAG trial insights.JACC Cardiovasc Interv2020;13:143-4

[59]

Casselman FP,Cammu G.Initial experience with an endoscopic radial artery harvesting technique.J Thorac Cardiovasc Surg2004;128:463-6

[60]

Ferdinand FD,Balkhy HH.Endoscopic conduit harvest in coronary artery bypass grafting surgery: an ISMICS systematic review and consensus conference statements.Innovations2017;12:301-19

[61]

Kiaii BB,Fox SA,Quantz MA.A prospective randomized study of endoscopic versus conventional harvesting of the radial artery.Innovations2017;12:231-8

[62]

Shapira OM,Anter E.Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: functional and histologic assessment of the conduit.J Thorac Cardiovasc Surg2006;131:388-94

[63]

Medalion B,Yosibash Z.Vasoreactivity and histology of the radial artery: comparison of open versus endoscopic approaches.Eur J Cardiothorac Surg2008;34:845-9

[64]

Gaudino MF,Ohmes LB.Open radial artery harvesting better preserves endothelial function compared to the endoscopic approach.Interact Cardiovasc Thorac Surg2019;29:561-7 PMCID:PMC6760280

[65]

Rahouma M,Benedetto U.Endoscopic versus open radial artery harvesting: a meta-analysis of randomized controlled and propensity matched studies.J Card Surg2017;32:334-41

[66]

Kristic I. Radial artery spasm during transradial coronary procedures. Available from: https://www.hmpgloballearningnetwork.com/site/jic/articles/radial-artery-spasm-during-transradial-coronary-procedures [Last accessed on 28 Nov 2023].

[67]

Gaudino M,Sandner S.Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS).Eur J Cardiothorac Surg2023;64:ezad163

[68]

Gaudino M,Pragliola C.Effect of target artery location and severity of stenosis on mid-term patency of aorta-anastomosed vs. internal thoracic artery-anastomosed radial artery grafts.Eur J Cardiothorac Surg2004;25:424-8

[69]

van Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K. Comparative anatomic studies of various arterial conduits for myocardial revascularization.J Thorac Cardiovasc Surg1990;99:703-7

[70]

Yie K,Oh SS,Shinn SH.Angiographic results of the radial artery graft patency according to the degree of native coronary stenosis.Eur J Cardiothorac Surg2008;33:341-8

[71]

Gaudino M,Benedetto U.Radial artery as a coronary artery bypass conduit: 20-year results.J Am Coll Cardiol2016;68:603-10

[72]

Kasahara H,Takahashi T,Mori M.Comparison of patency of single and sequential radial artery grafting in coronary artery bypass.Interact Cardiovasc Thorac Surg2022;34:515-22 PMCID:PMC8972210

[73]

Hosono M,Hirai H,Suehiro S.The risk factor analysis for the late graft failure of radial artery graft in coronary artery bypass grafting.Ann Thorac Cardiovasc Surg2019;25:32-8 PMCID:PMC6388303

[74]

Nakajima H,Toda K.A 10-year angiographic follow-up of competitive flow in sequential and composite arterial grafts.Eur J Cardiothorac Surg2011;40:399-404

[75]

Chardigny C,Acar J.Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery.Circulation1993;88:II115-27

[76]

Gaudino M,Luciani N,Possati G.Clinical and angiographic effects of chronic calcium channel blocker therapy continued beyond first postoperative year in patients with radial artery grafts: results of a prospective randomized investigation.Circulation2001;104:I64-7

[77]

Gaudino M,Nasso G,Canosa C.Is postoperative calcium channel blocker therapy needed in patients with radial artery grafts?.J Thorac Cardiovasc Surg2005;129:532-5

[78]

Miwa S,Koyama T,Cohen EA.Radial Artery Patency Study InvestigatorsRadial artery angiographic string sign: clinical consequences and the role of pharmacologic therapy.Ann Thorac Surg2006;81:112-8; discussion 119

[79]

Gaudino M,Fremes SE.Effect of calcium-channel blocker therapy on radial artery grafts after coronary bypass surgery.J Am Coll Cardiol2019;73:2299-306

[80]

Bakaeen FG,Ravichandren K.Right internal thoracic artery patency is affected more by target choice than conduit configuration.Ann Thorac Surg2022;114:458-66

[81]

Glineur D,Poncelet A.Comparison of bilateral internal thoracic artery revascularization using in situ or Y graft configurations: a prospective randomized clinical, functional, and angiographic midterm evaluation.Circulation2008;118:S216-21

[82]

Glineur D,Hanet C.Bilateral internal thoracic artery configuration for coronary artery bypass surgery: a prospective randomized trial.Circ Cardiovasc Interv2016;9:e003518 PMCID:PMC4949001

[83]

Parissis H,Al-Alao B.Off-pump coronary surgery: current justifications.Gen Thorac Cardiovasc Surg2014;62:660-70

[84]

Sousa Uva M,Oliveira AG.Early graft patency after off-pump and on-pump coronary bypass surgery: a prospective randomized study.Eur Heart J2010;31:2492-9

[85]

Houlind K,Holme SJ.Graft patency after off-pump coronary artery bypass surgery is inferior even with identical heparinization protocols: results from the Danish on-pump versus off-pump randomization study (DOORS).J Thorac Cardiovasc Surg2014;148:1812-9.e2

[86]

Hattler B,Shroyer AL.Off-pump coronary artery bypass surgery is associated with worse arterial and saphenous vein graft patency and less effective revascularization: results from the Veterans affairs randomized on/off bypass (ROOBY) trial.Circulation2012;125:2827-35

[87]

Noiseux N,Chartrand-Lefebvre C.Off-pump versus on-pump coronary artery bypass surgery: graft patency assessment with coronary computed tomographic angiography: a prospective multicenter randomized controlled pilot study.J Thorac Imaging2017;32:370-7

[88]

Zhou Z,Feng K.Randomized evidence on graft patency after off-pump versus on-pump coronary artery bypass grafting: an updated meta-analysis.Int J Surg2022;98:106212

[89]

Björklund E,Hansson EC.Secondary prevention medications after coronary artery bypass grafting and long-term survival: a population-based longitudinal study from the SWEDEHEART registry.Eur Heart J2020;41:1653-61 PMCID:PMC7194184

[90]

Kurlansky P,Prince S.Coronary artery bypass graft versus percutaneous coronary intervention: meds matter: impact of adherence to medical therapy on comparative outcomes.Circulation2016;134:1238-46

[91]

Pan E,Mennander A.Statins for secondary prevention and major adverse events after coronary artery bypass grafting.J Thorac Cardiovasc Surg2022;164:1875-86.e4

[92]

Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts.N Engl J Med1997;336:153-62

[93]

Kulik A,Boronat V.Intensive versus moderate statin therapy and early graft occlusion after coronary bypass surgery: the aggressive cholesterol therapy to inhibit vein graft events randomized clinical trial.J Thorac Cardiovasc Surg2019;157:151-61.e1

[94]

Gaudino M,Rahouma M.Operative outcomes of women undergoing coronary artery bypass surgery in the US, 2011 to 2020.JAMA Surg2023;158:494-502 PMCID:PMC9979009

[95]

Alam M,Elayda MA.Association of gender with morbidity and mortality after isolated coronary artery bypass grafting. A propensity score matched analysis.Int J Cardiol2013;167:180-4

[96]

Attia T,Houghtaling PL,Sabik EM.Does a similar procedure result in similar survival for women and men undergoing isolated coronary artery bypass grafting?.J Thorac Cardiovasc Surg2017;153:571-9.e9

[97]

Jawitz OK,Thibault D.Sex differences in coronary artery bypass grafting techniques: a society of thoracic surgeons database analysis.Ann Thorac Surg2022;113:1979-88

[98]

Rubens FD,Coutinho T,Sun LY.Sex differences after coronary artery bypass grafting with a second arterial conduit.J Thorac Cardiovasc Surg2022;163:686-95.e10

[99]

Gaudino M,Hameed I,Girardi LN.Differences in long-term outcomes after coronary artery bypass grafting using single vs multiple arterial grafts and the association with sex.JAMA Cardiol2020;6:401-9 PMCID:PMC7758835

[100]

Gaudino M,Sandner S.Randomized comparison of the outcome of single versus multiple arterial grafts trial (ROMA):women-a trial dedicated to women to improve coronary bypass outcomes.J Thorac Cardiovasc Surg2023;S0022-5223(23)00525Online ahead of print

[101]

Gaudino M,Mehran R,ROMA:Women Steering Committee and Investigators.ROMA:women: innovative approaches for the first cardiac surgery trial in women.Circulation2023;148:1289-91

[102]

Vrancic JM,Espinoza JC.Is sex a risk factor for death in patients with bilateral internal thoracic artery grafts?.J Thorac Cardiovasc Surg2019;158:1345-53.e1

[103]

Gaudino M,Fremes SE.Representation of women in randomized trials in cardiac surgery: a meta-analysis.J Am Heart Assoc2021;10:e020513 PMCID:PMC8475035

[104]

Lehtinen ML,Soletti G.Sex differences in saphenous vein graft patency: a systematic review and meta-analysis.J Card Surg2022;37:4573-8 PMCID:PMC9812911

[105]

Markman PL,Leong JY.Skeletonized internal thoracic artery harvesting reduces chest wall dysesthesia after coronary bypass surgery.J Thorac Cardiovasc Surg2010;139:674-9

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