Authors
Shengelia L.D., Konshina M.O., Sanakoev M.K., Fatulaev Z.F., Donakanyan S.A., Merzlyakov V.Yu.
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow
Abstract
It is known that coronary artery bypass grafting is still one of the main method of treatments from the point of increasing survival rates and avoidinig resergions and the risk of repeated interventions for most patients, in particular, in patients with multivessel coronary disease and diabetics. More than 45 years have passed since the first operation of coronary artery bypass grafting, and currently coronary artery bypass grafting is not only the most common operation in cardiovascular surgery, but also the “gold standard” for the treatment of the coronary heart disease. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. And the question of which grafts are more efficient and durable is becoming more and more urgent. The long-term benefit of the internal thoracic artery has long been proven and the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. It is not always possible to achieve complete revascularization with arterial grafts, which requires the use of venous grafts. Unfortunately, the saphenous vein graft does not have the same duration of functioning, which leads to the occurrence of dysfunctions and the development of repeated ischemic events. On the other hand, the radial and internal arteries are exposed to spasm and vulnerable to competitive blood flow In this paper, a detailed analysis of the main types of grafts in coronary surgery is carried out.
Keywords: coronary artery bypass grafting, radial artery, saphenous vein, left internal thoracic artery, bimammary bypass grafting.
References
1. Sigaev IYu, Keren MA. Indications,criteria, choice of the method of myocardial revascularization: European and Russian clinical guidelines data. Creative cardiology. 2018; 12(2): 67-176. (In Russ.)
2. Kazaryan AV, Sigaev IYu. The choice of conduits for repeated coronary bypass.Annaly khirurgii. 2017; 22(4): 197-204. (In Russ.)
3. Paez R, Junior J, JADE S, Berwanger O, et al. Coronary artery bypass surgery in Brazil: analysis of the national reality through the BYPASS registry. Braz J Cardiovasc Surg. 2019; 34(2): 142- 8. doi: 10.21470/ 1678-9741-2018-0313.
4. Favaloro R. Saphenous vein graft in the surgical treatment of coronary artery disease. Operative technique. J Thorac Cardiovasc Surg. 1969; 58(2): 178-85.
5. Tatoulis J, Buxton B, Fuller J. The right internal thoracic artery: the forgotten conduit: 5766 patients and 991 angiograms. Ann Thorac Surg 2011; 92: 9-15.
6. Jessen M. Efforts to improve bypass graft patency have not been “in vein” J Thorac Cardiovasc Surg. 2015; 150(4): 889-90. doi: 10.1016/j.jtcvs. 2015.07.099.
7. Weiss M, Nielsen P, James S, Thelin S, Modrau I. Clinical Outcomes After Surgical Revascularization Using No-Touch Versus Conventional Saphenous Vein Grafts: Mid-Term Follow-Up of Propensity Score Matched Cohorts. dr.med. 2021. doi: 10.1053/j.semtcvs.2021.12.002.
8. Puskas J, Williams W, Duke P, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003; 125: 797-808.
9. Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial. J Thorac Cardiovasc Surg. 2015; 150(4): 880-8. doi: 10.1016/j.jtcvs.2015.07.027.
10. Samano N, Geijer H, Liden M, Fremes S, Bodin L, Souza D. The no-touch saphenous vein for CABG maintains a patency after 16 years comparable to the left internal thoracic artery. A Randomized Trial. J Thorac Cardiovasc Surg. 2015; 150: 880-8.
11. Dreifaldt M, Souza D, Bodin L, Shi-Wen X, Dooley A, Muddle J, et al. The vasa vasorum and associated endothelial nitric oxide synthase is more important for saphenous vein than arterial bypass grafts. Angiology. 2013; 64: 293-9.
12. Osgood M, Hocking K, Voskresensky I, Li F, Komalavilas P, et al. Surgical vein graft preparation promotes cellular dysfunction, oxidative stress, and intimal hyperplasia in human saphenous vein. J Vasc Surg. 2014; 60: 202-11.
13. Nolte A, Secker S, Walker T, Greiner T, et al. Veins are no arteries: even moderate arterial pressure induces significant adhe- sion molecule expression of vein grafts in an ex vivo circulation model. J Cardiovasc Surg. 2011; 52: 251-9.
14. Vijayan V, Shukla N, Johnson J, et al. Long-term reduction of medial and intimal thickening in porcine saphenous vein grafts with a polyglactin biodegradable external sheath. J Vasc Surg. 2004; 40: 1011-9.
15. Taggart D, Nir R, Bolotin G. New technologies in coronary artery surgery. Ram- bam Maimonides Med J. 2013; 4: e0018.
16. Hinokiyama K, Valen G, Tokuno S, Vedin J, Vaage J. Vein graft harvesting induces inflammation and impairs vessel reactivity. Ann Thorac Surg. 2006; 82: 1458-64.
17. Subodh V, Lovren F, Pan Y, Yanagawa B, et al. Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the patent saphenous vein graft study. Eur J Cardiothorac Surg. 2014; 45(4): 717-25. doi: 10.1093/ejcts/ezt560.
18. Loesch A, Pinheiro B, Dashwood M. Why Use the Radial Artery? The Saphenous Vein is the Second Graft of Choice for CABG in Brazil. Braz J Cardiovasc Surg. 2019; 27; 34(4): 480-483. doi: 10.21470/ 1678-9741-2019-0212.
19. Kaabak AM, Merzlyakov VYu, Klyuchnikov IV, Skopin AI, Zhelikhazheva MV. One-time application of traditional (open) and endoscopic methods of autovenous graft sampling during coronary artery bypass grafting. Thoracic and cardiovascular surgery. 2022; 64(2): 217-221.
20. Kaabak AM, Merzlyakov VYu, Klyuchnikov IV, Mammadova SKK, Baichurin RK. Methods of taking autovenous grafts for coronary artery bypass grafting. Bulletin of the A.N. Bakulev National Agricultural Academy of the Russian Academy of Sciences. Cardiovascular diseases. 2021; 22(6): 643-653.
21. Kovalenko OA, Musin DE, Krymov KV, Alshibaya MD. Long-term results of coronary bypass surgery using internal thoracic and radial arteries. Clinical physiology of blood circulation. 2019; 16(4): 299-305.
22. Carpentier A, Guermonprez J, Deloche A, et al. The aorta-to-coronary radial artery bypass graft: a technique avoiding patho- logical changes in grafts. Ann Thorac Surg. 1973; 16: 111-121.
23. Neumann F, Sousa-Uva M, Ahlsson A, Alfonso F, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 87-165. doi: 10.1093/eurheartj/ehy394.
24. Lawton J, Tamis-Holland J, Bangalore S, Bates E, et al. 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. Circulation. 2022; 145(3): e4-e17. doi: 10.1161/cir.0000000000001039.
25. Verma S, Szmitko P, Weisel R, Bonneau D, Latter D, Errett L, et al. Should radial arteries be used routinely for coronary artery bypass grafting? Circulation. 2004; 110(5): e40-6. doi: 10.1161/01.
26. Greene M, Malias M. Arm complications after radial artery procurement for coronary bypass operation. Ann Thorac Surg. 2001; 72(1): 126-8. doi: 10.1016/s0003-4975(01)02680-7.
27. Budillon A, Nicolini F, Agostinelli A, et al. Complications after radial artery harvesting for coronary artery bypass grafting: our experience. Surgery. 2003; 133(3): 283-7. doi: 10.1067/msy.2003.43.
28. Goldman S, Sethi G, Holman W, et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial. Jama. 2011; 305(2): 167-74. doi: 10.1001/jama.2010.1976.
29. Head S, Milojevic M, Taggart D, Puskas J. Current Practice of State-of-the-Art Surgical Coronary Revascularization. Circulation. 2017; 136(14): 1331-1345. doi: 10.1161/circulationaha.116.022572.
30. Benedetto U, Altman D, Gerry S, Gray A, et al. Arterial Revascularization Trial investigators. Pedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial. J Thorac Cardiovasc Surg. 2016; 152(1): 270-6. doi: 10.1016/j.jtcvs.2016.03.056.
31. Buxton B, Hayward P, Raman J, et al. Long-Term Results of the RAPCO Trials. Circulation. 2020; 142(14): 1330-1338. doi: 10.1161/circulationaha.119.045427.
32. Taggart D, Benedetto U, Gerry S, Altman D, et al. Arterial Revascularization Trial Investigators. Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years. N Engl J Med. 2019; 380(5): 437-446. doi: 10.1056/nejmoa1808783.
33. Gaudino M, Bakaeen F, Benedetto U, Rahouma M, Franco A, Tam D, at al. Use Rate and Outcome in Bilateral Internal Thoracic Artery Grafting: Insights From a Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018; 7(11): e009361. doi: 10.1161/jaha.118.009361.
