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. 2019 Jan;17(1):359-367.
doi: 10.3892/etm.2018.6929. Epub 2018 Nov 6.

Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique

Grigore Tinica  1   2 , Raluca Ozana Chistol  3 , Diana Bulgaru Iliescu  4   5 , Cristina Furnica  5   6
Affiliations

Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique

Grigore Tinica et al. Exp Ther Med. 2019 Jan.

Abstract

The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting.

Keywords: anastomosis angle; anastomosis type; composite grafting; coronary artery bypass grafting; long-term patency.

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Figures

Figure 1.
Figure 1.
Measurement of (A) distal side-to-side, (B) distal end-to-side and (C) Y anastomosis angle on computerised tomography images.
Figure 2.
Figure 2.
Coronary computed tomography angiography reconstruction demonstrating a proximal Y anastomosis of the right internal thoracic artery with the left internal thoracic artery. The left internal thoracic artery was used in situ and the right internal thoracic artery as a free graft with sequential distal anastomoses to CX territory.
Figure 3.
Figure 3.
saphenous vein graft with two side-to-side anastomoses used to revascularise CX territory.
Figure 4.
Figure 4.
ROC curve fr identifying the cut-off value of the distal anastomosis angle. ROC, receiver operating characteristic.
See this image and copyright information in PMC

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