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Background Composite T-grafts between left internal mammary artery (LIMA) and radial artery (RA) are a common concept in complete arterial myocardial revascularization. The aim of the present study was to investigate whether the use of the great saphenous vein (SV) instead of RA leads to comparably good results in terms of outcome in this context. Methods Patients who underwent myocardial revascularization with a T-graft using RA or a segment of SV to the right coronary artery or circumflex artery between the beginning of 2014 and the end of 2019 at the Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel were included. To minimize surgical variation, only patients were observed by a single senior surgeon in the department. Exclusion criteria were previous cardiac surgery, preoperative extracorporeal circulatory support, off-pump surgery, additional aortocoronary bypasses, and cardiac combination procedures. Results A total of 115 patients were studied. In 55 patients, the T-graft was placed between the LIMA and SV, and in 60 patients, the T-graft was placed between the LIMA and RA. Patients in the SV group were older (70.6 ± 7.8 vs. 58.5 ± 10.0 years; p < 0.001), suffered more frequently from non-ST elevation myocardial infarction (12.7 vs. 1.7%; p = 0.027), arterial hypertension (83.6 vs. 61.7%; p = 0.009), and atrial fibrillation (18.2 vs. 1.7%; p = 0.003). They were less likely to be active smokers (16.4 vs. 38.3%; p = 0.009) and less likely to have a history of variceal surgery (0 vs. 15.0%; p = 0.003). Calcification of the ascending aorta was also found more frequently in the saphenous group (18.2 vs. 3.3%, p = 0.009). Operative times and number of distal anastomoses did not differ significantly between the two groups. Postoperative deliriums (16.7 vs. 5.0%; p = 0.043) were observed more frequently in venous patients. Wound healing disorders of the leg (11.1 vs. 0%; p = 0.011) did only occur in SV group and wound infections of the arm only in the RA group. Complete follow-up was achieved in 74.8% of cases. Median follow-up was 60.3 (39.6; 73.2) months. Serious adverse cardiac–cerebral events (19.0 vs. 22.7%; p = 0.675) and mortality (14.5 vs. 6.7%; p = 0.167) did not differ significantly between the groups at follow-up. Myocardial infarction (0 vs. 2.5%; p = 1.000) and stroke (0 vs. 7.5%; p = 0.245) were observed exclusively in RA group. Percutaneous coronary intervention was required in single patients of RA group (0 vs. 15.0%; p = 0.028). No patient from either group underwent repeat coronary artery bypass grafting (CABG). The patients of SV group had angiographically competent grafts and open anastomoses. Graft failure was noted in a single patient in RA group, in which case both grafts and native coronary vessels were stented. Kaplan–Meier analysis revealed no significant survival disadvantage for SV group compared with RA group. Conclusion CABG with a composite T-graft between LIMA and a segment of SV may be comparable to bypass surgery with a composite T-graft between LIMA and RA. This might be true in terms of morbidity and mortality over an intermediate-term observation period. The results of our studies give rise to the hypothesis that the decision not to perform aortic bypass anastomosis may be more important than the choice of graft material. [ABSTRACT FROM AUTHOR]

Objectives. Despite guideline recommendations for use of bilateral internal mammary artery (BIMA) in coronary artery bypass grafting (CABG), a large proportion of patients still receive saphenous vein grafts (SVG). We herein aimed to identify reasons for SVG use at a center with a BIMA utilization rate between 60 and 70% and compare outcomes of patients undergoing CABG with either BIMA or left internal mammary artery (LIMA) plus SVG. Methods. Between 2013 and 2022, 4145 consecutive patients underwent isolated CABG at our center. Of those, 2067 patients received BIMA (group 1) and 1206 patients received LIMA/SVG (group 2). A propensity score-matched analysis was performed to adjust for baseline differences. Results. Group 2 presented with higher age, more female patients, and more patients with acute coronary syndrome including NSTEMI/STEMI with more urgent/emergency CABG. In unadjusted analysis group 2 presented adverse 30-day outcomes compared to group 1 with a higher mortality (18/2067, 0.9% vs. 34/1206, 2.8%; p < 0.001), higher rate of re-revascularization (52/2067, 2.5% vs. 50/1206, 4.1%; p < 0.001), more stroke (20/2067; 1.0% vs. 33/1206, 2.7%; p < 0.001), and more postoperative renal failure (17/2067, 0.8% vs. 27/1206, 2.2%; p = 0.001). After adjustment for baseline characteristics, 30-day outcomes were comparable. Conclusions. After adjustment for baseline characteristics no differences in outcomes were found between groups suggesting a safe applicability of BIMA even in patients with acute coronary syndrome undergoing urgent/emergency CABG. Reasons for SVG use were higher age, female gender, and acute coronary syndrome with urgent/emergency CABG. Outcomes of both groups were excellent with low rates of primary endpoints. [ABSTRACT FROM AUTHOR]

Atherosclerosis is one of the leading non-communicable diseases in Sri Lanka. Analysis of fatty acid composition in blood vessels is important in understanding the development of atherosclerosis. Here, analyses of fatty acid profiles in major arteries which are commonly used in Coronary Artery Bypass Graft surgery (CABG) were subjected to investigation. Patients (n = 27) undergoing elective CABG were enrolled in the study. A small biopsy segment of the saphenous vein (SV), radial artery (RA), and left internal mammary artery (LIMA) of patients was obtained during the surgery. The fatty acid (FA) profile of tissue samples was analyzed using Gas Chromatography-Mass Spectroscopy (GCMS). Among the different arteries tested, palmitic acid and stearic acid were the predominant fatty acids. As far as monounsaturated FA (MUFA) are concerned, oleic acid was found to be the most abundant MUFA in vessels. The FA profile of LIMA samples had a higher SFA percentage and lower unsaturated FA percentage compared to other vessels. Furthermore, the vessel samples of RA indicated the highest percentage of pro-inflammatory ω -6 polyunsaturated fatty acids (PUFA) as well as a higher percentage ratio between ω -6: ω -3 PUFA. The fatty acid composition and ω -6: ω -3 PUFA ratio suggests that LIMA graft is preferred for CABG over RA and SV. [ABSTRACT FROM AUTHOR]

Background: Graft patency is a fundamental predictor of long-term survival after coronary artery bypass surgery. Left and right internal thoracic artery (arterial) graft patency has been shown to be superior to that of saphenous vein grafts. More recently, the radial artery has been used as an a ortocoronary graft, but little is known about the midterm and long-term patency of this conduit. The ultimate goal of this operation is to achieve complete revascularization of the patient with conduits that will remain patent for the duration of the patient's lifetime. The excellent patency rates achieved with the pedicled left internal mammary artery are well described. Over the past decade, there has been considerable interest in whether the left internal mammary radial artery may provide results comparable to the arterial conduit. However, other studies have described that mild proximal stenosis of target vessels correlated with graft occlusion when an RA graft was used. Thus, we compared the short- and long-term results of patients who received an RA graft to the OM with those of patients who received an SVG. Methods: Following approval by the ethics and research committee of Kasr el Ainy faculty of Medicine Cairo University, and obtaining an informed consent, a prospective randomized clinical study was conducted on FIFTY who were operated upon with CABG. Requiring in addition to LIMA to LAD, revascularization of an obtuse marginal. These patients included 25 patients who received radial artery as the conduit. The selected patients for this study were evaluated postoperatively by MSCT angiography to comparative study between radial artery versus saphenous vein grafts patency after 5 years. Results: In our study according to graft patency by MSCT postoperative after 5 years of both groups showed statistically significant difference in group A which is p value 0.047 in group A 22 patients (88.0%) with radial to OM graft were patent while 3 patients (12.0%) with radial to OM were occluded. But in group B 16 patients (64.0%) with saphenous to OM graft were patent while 9 patients (36%) with saphenous to OM were occluded. Conclusion: In the long-term study, there was significant difference between total arterial revascularization and conventional CABG. Total arterial revascularization having low operative mortality and morbidity [ABSTRACT FROM AUTHOR]

Background: previous studies evaluating external stents for saphenous vein grafts (SVG) in CABG were limited to on-pump isolated CABG and single grafting technique with one external stent per patient. The objective of this prospective study was to evaluate the safety and the short-term performance of external stents in a heterogeneous group of patients who underwent on- and off-pump CABG, single and sequential grafting. Methods: 102 patients undergoing CABG were enrolled in two centers. All patients received internal mammary artery to the left anterior descending artery and additional arterial and/or venous grafts. In each patient, at least one SVG was supported with an external stent. Grafts' patency and SVG lumen uniformity were assessed using CT angiography at a pre-defined time window of 6–12 months post procedure. All patients were prospectively followed-up via phone call and/or visit every 6 months for Major Adverse Cardiac and Cerebrovascular Events. Results: 51 patients (50%) underwent off-pump CABG and 23 patients (23%) were grafted with bilateral internal mammary arteries. Each patient received one or more SVG grafted in a sequential technique (44%) or as a single graft (56%). All SVG were externally stented in 84% of patients and in 16% (n = 16) one SVG was stented and one remained unsupported. At 6–12 months, patency rates of LIMA, RIMA, externally stented SVG and none-stented SVG were 100, 100, 98 and 87.5% respectively. 90% of the externally stented SVG had uniform lumen compared to 37% of the non-stented SVG. Clinical follow-up was completed for all patients with a mean duration of 20 months (range 6–54 months). During follow up period, one patient experienced myocardial infarction due to occlusion of the LIMA-LAD graft and one patient experienced a transient ischemic attack. Conclusions: External stenting of SVG is feasible and safe in CABG setting which includes off pump CABG and sequential SVG grafting and associated with acceptable early patency rates. Trial registration: Study was registered at ClinicalTrials.gov. NCT01860274 (initial release 20.05.2013). [ABSTRACT FROM AUTHOR]

aimed to examine the short-term effect of the no-touch technique on the patency rate of a great saphenous vein (GSV) bridge used during off-pump coronary artery bypass grafting (OPCABG). Methods: Between June 2018 and September 2020, 140 patients undergoing OPCABG, with grafts obtained from the GSV using the "no-touch" technique or the left internal mammary artery (LIMA), were enrolled in this study. The early clinical results and short-term patency rate of the OPCABG were evaluated at a three-month follow-up by comparing the patency rate of the LIMA bridge and the GSV bridge obtained by the no-touch technique. This study also analyzed the impacts of the postoperative complications of the lower limbs and the distribution area of diseased vessels on the patency rate of a GSV bridge obtained by the no-touch technique at an early stage. Results: No perioperative death or adverse cardiovascular or cerebrovascular events occurred in the 140 patients undergoing OPCABG. The difference in the early patency rate between the GSV bridge obtained by the no-touch technique and the LIMA bridge was not statistically significant (95.9% vs 97.1%, p = 0.501). There was no significant difference in the patency rate between an end-to-side anastomosed venous bridge and a LIMA bridge (95.0% [248/261] vs 97.1% [136/140], p = 0.314). The overall patency rate of a no-touch vein bridge in the right coronary artery region was lower than it was in the left coronary artery region (93.8% [165/176] vs 97.9% [183/187], p = 0.049). Conclusion: The no-touch technique may improve the early patency rate of a GSV bridge, and its effect is similar to that of a LIMA bridge. [ABSTRACT FROM AUTHOR]

Introduction: The value of color Doppler ultrasonography (CDUS) with the supraclavicular approach for preoperative evaluation of the native left internal mammary artery (LIMA) as well as for the postoperative detection of LIMA graft patency was recently suggested. However, the parameters such as the flow volume and pulsatile index (PI) have not been studied in detail. Objectives: The objectives of this study were to analyze the LIMA data in the perioperative period and explore the relationships between the intraoperative graft flow with transit-time flow measurement (TTFM) and the postoperatively measured parameters with CDUS. Methods: Fifty-eight patients with significant stenosis (≥70%) or occlusions in left anterior descending artery (LAD) who were referred for isolated coronary artery bypass grafting (CABG) were enrolled in this study and examined by CDUS prior to CABG from April to July 2016. The perioperative measurements of proximal LIMA by CDUS were compared. In addition, the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) and PI, and the immediate postoperative measurements of CDUS in LIMA bypassed grafts was statistically analyzed. Results: Six patients were excluded due to screening failure, or insufficient visualization of CDUS images for analysis. Fifty-two patients with in situ LIMA-LAD graft, with or without additional arterial grafts or saphenous vein grafts, were included in the final analysis. The postoperative diameters of proximal LIMA were not significantly different from preoperative diameters (2.21 ± 0.18 vs. 2.27 ± 0.22 mm, p = 0.070). The flow volume on the early postoperative CDUS significantly increased (39.77 ± 21.59 vs. 25.96 ± 13.17 mL/min, p < 0.001) and the PI significantly decreased (1.43 ± 0.46 vs. 4.20 ± 1.49, p < 0.001) versus those of preoperative measurements. The MGF had a moderate correlation with the flow volume on the early postoperative CDUS (r = 0.414, p = 0.002), and the PI by TTFM had a weak correlation with that by CDUS (r = 0.353, p = 0.010) as well. Conclusions: The MGF and PI by TTFM in CABG were associated with in situ LIMA graft parameters measured by CDUS studies. CDUS is a useful functional noninvasive tool for the preoperative screening and postoperative follow-up of patients with in situ LIMA bypass. [ABSTRACT FROM AUTHOR]

Background: Total arterial revascularisation may prolong postoperative survival following coronary surgery due to avoidance of late saphenous vein graft (SVG) failure leading to ischaemic cardiac events. The left internal mammary artery (LIMA) is routinely used for CABG but harvest may adversely affect lung function and reduce sternal vascular supply. Early experience of a novel reconstruction with exclusive reliance on two radial arteries (RA) joined as a Y graft (RARAY) is presented.Methods: One RA is anastomosed to the ascending aorta and used to revascularise the left anterior descending artery coronary territory; and a second RA is joined to the first 4-6 cm from the origin, approximating the lateral border of the pulmonary artery and used to revascularise the circumflex and right coronary territories. No LIMA is used. The radial artery was harvested open with diathermy and metal clips and since 2008, all patients received intravenous vasoconstrictors from the commencement of the anaesthetic.Results: From 2002 to 2019, 28 patients underwent RARAY for specific indications of prior use or reasons to avoid LIMA harvest, preservation of lung function, minimisation of bleeding risk from antiplatelet agents and extra length of RA to graft distal coronary targets beyond usual reach for LIMA. There was no RA spasm, no in-hospital death and no patient returned with symptoms of angina.Conclusions: The early experience of the RARAY operation for three coronary territory revascularisations are satisfactory. [ABSTRACT FROM AUTHOR]

Coronary artery bypass grafts (CABGs), including saphenous vein grafts (SVGs) or left internal mammary artery (LIMA) grafts, are recently applied to treat coronary artery aneurysm (CAA). Surgical outcomes are considered to be related to surgical strategies (types of the bypass graft and whether CAA ligated or not) and the size of the CAA (usually characterized by diameter). However, the understanding of the relationship between the surgical outcomes and the abovementioned factors is limited. Previous studies related to CABG treatments have shown hemodynamic studies could help evaluate surgical outcomes through graft mass flow rate, wall shear stress (WSS), and oscillatory shear index (OSI). It is believed that the hemodynamic study of applying CABGs to CAA, which is not studied yet, could help us understand the different CABG surgeries. The aim of the study was to evaluate the hemodynamic differences among different surgical methods. To do this, eight three-dimensional models were constructed, representing application of SVGs and LIMA grafts to CAAs (whether ligated or not) with diameters two, three, and five times the normal diameter, to perform computational fluid dynamics (CFD) simulation. The lumped-parameter model (LPM) was coupled to the boundary of the 3D models which increase the complexity of the simulation, but it can ensure the stability of the simulation boundary conditions. The results show that SVG (no matter whether ligated or not) hemodynamic characteristics are positive, with an average high graft mass flow rate of 70 ml/min, an average WSS of 0.479 Pa, and a low OSI of 0.001. LIMA with CAA ligation has the same characteristics with higher WSS (average 1.701 Pa). The hemodynamic characteristics of LIMA without CAA ligation are negative, including high reverse mass flow rate and high OSI (0.367). The results indicate that the surgical outcomes of LIMA with CAA ligation are likely to be the best among these models. The surgical outcomes of LIMA without CAA ligation seem to be undesirable due to the high reverse mass flow and high OSI. The CAA diameter may not have a significant effect on surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass grafting surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. The purpose of this study was to explore the differences in different conduit materials used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.Methods: We retrospectively collected the data of 410 patients who underwent isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the LAD revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA) group (n = 333), a right IMA (RIMA) group (n = 34) and a great saphenous vein (SVG) group (n = 43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates.Results: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume (MGF) (37.15 ± 23.29 vs 29.71 ± 20.94 ml/min, P = 0.036), however, had a lower value of pulse index (PI) (2.07 ± 0.62 vs 2.65 ± 1.01, P<0.001). There was no significant difference between the two groups in terms of DF (P>0.05). Compared with the RIMA-LAD group, the SVG-LAD group just had a lower value of PI (2.07 ± 0.62 vs 2.56 ± 0.96, P = 0.029). However, there was no significant difference between the two groups in terms of MGF and DF (P>0.05). Compared with the LIMA-LAD group, the RIMA-LAD group had a slightly lower value of DF (70.76 ± 11.87 vs 74.06 ± 7.09, P = 0.018), while there was no difference in terms of MGF and PI between the two groups (P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), that of RIMA-LAD group was 97.06% (33/34), and that of SVG-LAD group was 100%. There was no difference among the three groups in patency rate (P = 0.405).Conclusions: SVG-LAD has a higher intraoperative MGF and a lower value of the PI than both LIMA-LAD and RIMA-LAD. RIMA has a higher preoperative blood flow and a lower value of the PI than LIMA; however, there were no significant difference between RIMA grafted to LAD and LIMA grafted to LAD in terms of MGF, PI and DF. In situ skeletonized RIMA did not increase blood flow compared to pedicled LIMA. [ABSTRACT FROM AUTHOR]