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. 2024 Feb 27:11:1285685.
doi: 10.3389/fcvm.2024.1285685. eCollection 2024.

Consensus statement-graft treatment in cardiovascular bypass graft surgery

Maximilian Y Emmert  1   2 , Johannes Bonatti  3 , Etem Caliskan  1 , Mario Gaudino  4 , Martin Grabenwöger  5   6 , Martin T Grapow  7 , Paul Phillip Heinisch  8 , Teresa Kieser-Prieur  9 , Ki-Bong Kim  10 , Attila Kiss  11 , Fatima Mouriquhe  12 , Markus Mach  13 , Adrianna Margariti  14 , John Pepper  15 , Louis P Perrault  12 , Bruno K Podesser  11 , John Puskas  16 , David P Taggart  17 , Om P Yadava  18 , Bernhard Winkler  6   11   19
Affiliations

Consensus statement-graft treatment in cardiovascular bypass graft surgery

Maximilian Y Emmert et al. Front Cardiovasc Med. .

Abstract

Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery. While there is little doubt about the benefits, the patency rates are constantly under debate. Despite its acknowledged limitations in terms of long-term patency due to intimal hyperplasia, the saphenous vein is still the most often used graft. Although reendothelialization occurs early postoperatively, the process of intimal hyperplasia remains irreversible. This is due in part to the persistence of high shear forces, the chronic localized inflammatory response, and the partial dysfunctionality of the regenerated endothelium. "No-Touch" harvesting techniques, specific storage solutions, pressure controlled graft flushing and external stenting are important and established methods aiming to overcome the process of intimal hyperplasia at different time levels. Still despite the known evidence these methods are not standard everywhere. The use of arterial grafts is another strategy to address the inferior SVG patency rates and to perform CABG with total arterial revascularization. Composite grafting, pharmacological agents as well as latest minimal invasive techniques aim in the same direction. To give guide and set standards all graft related topics for CABG are presented in this expert opinion document on graft treatment.

Keywords: CABG; VEST; endothelium; heart; radial artery.

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Conflict of interest statement

EC is a member of the registry advisory committee (RAC). LP is a member of the RAC and is a consultant for Marizyme. ME is the principal investigator of the registry, the chair of the RAC and a consultant for Marizyme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Overview graft treatment, handling and related topics.
Figure 2
Figure 2
Visual abstract graft treatment in coronary artery bypass surgery.
Figure 3
Figure 3
Pathway from bypass graft failure to early graft atherosclerosis.
See this image and copyright information in PMC

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