Use of multiple artery grafts to ensure long-termgraft patency in coronary bypass surgeries

Abstract

AimWhen selecting a graft for coronary artery bypass surgery (CABG), it is necessary to consider the quality of life and life expectancy of the patient besides ensuring complete revascularization. Use of multiple artery grafts confers the advantage over venous grafts because of their longer patency rates. The aim of this study is to evaluate our experiences in the use of arterial grafts and draw attention to the use of multiple artery grafts. Accordingly, coronary bypass surgeries that we have performed by using multiple arterial grafts were reviewed in our study.MethodBetween January 2017 and December 2017, 10 patients (8 males average age: 52.75 2 females average age: 61) had undergone CABG surgery by using multiple arterial grafts. We used the left internal mammary artery (LIMA) and radial artery (RA) in 2 patients, LIMA and right internal mammary artery (RIMA) in 6 patients and LIMA-RIMA and radial artery in 2 patients. In 2 of these patients, a T-graft was constructed by anastomosing the proximal end of the free RIMA to the side of the attached LIMA. In all cases, the radial artery was proximally anastomosed to the aorta. All patients were followed up in the intensive care unit for 2 days. Patients were discharged from the hospital in 5-6 days on average.ResultsPatients were evaluated in terms of operative mortality, cross clamp time, intensive care and hospitalization period, pain in the incision area, management of post-extubation saturation levels, postoperative complications, recurrent angina, myocardial infarction (MI) and reoperation. No complications were reported during the early period of our evaluations. Although low levels of saturation were detected during this time in patients for whom bilateral IMA was used, saturation increased in the following days with no complications. No sternal dehiscence or infections were observed in patients. Non-steroidal anti-inflammatory (NSAI) and paracetamol anti-analgesics were given to all patients. For measurement of incision area pain, a pain index test was implemented.ConclusionIn patients, whose venous grafts are used following CABG, early period graft thromboses lead to repetitive interventional operations and increase in re-operations. Although the superiority of CABG operation versus stent operation is accepted for multiple vein patients, many cardiologists and patients carry objections against the repetitive interventional operations that may arise due to early graft failure and the consequent increase in early period mortality and morbidity risk. We believe that we can overcome these risks by use of multiple artery grafts which allow for a higher patency rate over the long term.

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