Asvin M. Ganapathi, MD (left), and Nahush A. Mokadam, MD (right)
Central Message.
Real-time assessment of graft patency for coronary artery bypass grafting is an important component of the operation, particularly for arterial grafts. Understanding and knowledge of the application of various techniques for flow assessment is essential to making informed decisions in the operating room regarding graft patency.
Although congenital heart disease led to the earliest heart operations, coronary artery bypass grafting (CABG) has since become the flagship operation for cardiac surgeons. Since the first CABG operation performed by Dr Favaloro in 1967, the treatment of coronary disease has been heavily reliant on surgical therapy, even with the recent advent of percutaneous coronary intervention.1 While most of cardiac surgery has evolved significantly since the 1960s, current coronary surgery is similar to what was described by Dr Favaloro and later by Dr Loop and colleagues: use of the left internal mammary artery and saphenous vein grafts.2,3
However, recent data have demonstrated the long-term benefits of multiple arterial grafting (MAG),4,5 bringing forth intricacies that are distinct from saphenous vein grafts. In this issue of the Journal, Ahkrass and colleagues6 provide an expert summary of the various techniques to verify the function of bypass graft. They detail common pitfalls that can affect grafts, as well as how to best interpret the findings assessed. Astutely pointed out is that measurement of flow becomes very important with MAG when bypasses are often based off only 1 or 2 inflow sources.
As the subspecialty of coronary surgery continues to evolve, particularly with the use of MAG and off-pump CABG, it is imperative that those performing it be familiar with the methods of intraoperative graft verification. One of the first lessons that surgeons learn as an intern is the adage “trust but verify.” With the tools at our disposal, cardiovascular surgeons will be able to improve graft and patient outcomes through our skills with immediate verification of the results.
Footnotes
Disclosures: Dr Mokadam is a consultant and investigator for Abbott, Medtronic, Carmat, and SynCardia. Dr Ganapathi reported no conflicts of interest.
The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
References
- 1.Effler D.B., Favaloro R.G., Groves L.K. Coronary artery surgery utilizing saphenous vein graft techniques. Clinical experience with 224 operations. J Thorac Cardiovasc Surg. 1970;59:147–154. [PubMed] [Google Scholar]
- 2.Loop F.D., Lytle B.W., Cosgrove D.M., Stewart R.W., Goormastic M., Williams G.W., et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314:1–6. doi: 10.1056/NEJM198601023140101. [DOI] [PubMed] [Google Scholar]
- 3.McNeely C., Markwell S., Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 Medicare population. Ann Thorac Surg. 2016;102:132–138. doi: 10.1016/j.athoracsur.2016.01.016. [DOI] [PubMed] [Google Scholar]
- 4.Nowacki M., Nazarewski L., Pokrywczynska M., Kloskowski T., Tylock D., Pietkun K., et al. Long-term influence of bone marrow-derived mesenchymal stem cells on liver ischemia-reperfusion injury in a rat model. Ann Transplant. 2015;20:132–140. doi: 10.12659/AOT.892364. [DOI] [PubMed] [Google Scholar]
- 5.Rocha R.V., Tam D.Y., Karkhanis R., Nedadur R., Fang J., Tu J.V., et al. Multiple arterial grafting is associated with better outcomes for coronary artery bypass grafting patients. Circulation. 2018;138:2081–2090. doi: 10.1161/CIRCULATIONAHA.118.034464. [DOI] [PubMed] [Google Scholar]
- 6.Akhrass R., Bakaeen F.G. Intraoperative graft patency validation: friend or foe? J Thorac Cardiovasc Surg Tech. 2021;7:131–137. doi: 10.1016/j.xjtc.2020.12.040. [DOI] [PMC free article] [PubMed] [Google Scholar]