Our Summary

For the past half-century, doctors have been using a vein from the leg (the saphenous vein) to perform a type of heart surgery known as a coronary artery bypass graft. However, this method isn’t perfect – it doesn’t always last long-term, and can lead to worse health outcomes compared to using a different artery (the internal thoracic artery).

Because of these results, there’s been interest in using only arteries for this type of surgery, especially for patients with disease in multiple vessels. A new method involves using a Y- or T-shaped graft based on the internal thoracic artery in its original location, which allows for more extensive use of arteries to improve blood flow in both the left and right areas of the heart. This technique has shown promising results in terms of graft survival rate, improved heart muscle performance, and long-term health outcomes.

However, there are conflicting results when it comes to using the saphenous vein in a composite graft. This article discusses a recent surgical strategy of using the saphenous vein as part of a composite graft based on the internal thoracic artery in its original location.

FAQs

  1. What is a coronary artery bypass graft and how is it traditionally performed?
  2. What are the potential benefits of using the internal thoracic artery instead of the saphenous vein for CABG?
  3. What is the recent surgical strategy involving the saphenous vein as part of a composite graft?

Doctor’s Tip

Overall, it’s important to discuss with your doctor the best options for your specific situation when considering CABG surgery. They may recommend using arteries rather than veins for better long-term outcomes, or they may suggest a combination of both depending on your individual needs. It’s important to follow your doctor’s recommendations and to keep up with regular check-ups to monitor the success of the surgery.

Suitable For

Patients who are typically recommended coronary artery bypass graft (CABG) surgery include those with:

  1. Severe coronary artery disease, where the arteries supplying blood to the heart are blocked or narrowed.
  2. Multiple blockages in the coronary arteries.
  3. Unsuccessful results from other treatments such as medication or angioplasty.
  4. Left main coronary artery disease.
  5. Heart failure.
  6. Diabetes.
  7. Previous heart attack.
  8. Chest pain (angina) that interferes with daily activities.
  9. High risk of heart attack or death due to coronary artery disease.

Overall, the decision to recommend CABG surgery is based on individual factors such as the severity of the coronary artery disease, the patient’s overall health, and the potential benefits and risks of the surgery. It is important for patients to discuss their options with their healthcare provider to determine the best treatment plan for their specific condition.

Timeline

Before the surgery, a patient will typically undergo several tests and evaluations to determine the severity of their heart disease and their overall health. This may include a physical examination, blood tests, imaging tests such as an angiogram, and possibly a stress test.

During the surgery, the patient is placed under general anesthesia and the chest is opened to access the heart. The surgeon then takes a blood vessel (either a vein or artery) from another part of the body and attaches it to the blocked or narrowed coronary artery to create a new pathway for blood flow. This allows the blood to bypass the blockage and reach the heart muscle.

After the surgery, the patient will spend some time in the intensive care unit for monitoring and recovery. They will likely experience some pain and discomfort at the incision site, but medications will be given to help manage this. Physical therapy and cardiac rehabilitation may be recommended to help the patient regain strength and improve heart function.

In the weeks and months following the surgery, the patient will need to make lifestyle changes to improve their heart health, such as quitting smoking, eating a healthy diet, exercising regularly, and taking prescribed medications. Regular follow-up appointments with their healthcare team will be important to monitor their progress and make any necessary adjustments to their treatment plan.

What to Ask Your Doctor

  1. What are the potential benefits of using only arteries for a coronary artery bypass graft (CABG) surgery compared to using a vein from the leg?

  2. What are the risks or potential complications associated with using a composite graft that includes both the saphenous vein and internal thoracic artery?

  3. How long can I expect the grafts to last if I undergo a CABG surgery using a composite graft technique?

  4. Are there any specific factors or conditions that make me a better candidate for a CABG surgery using only arteries versus a composite graft?

  5. How does the success rate of a CABG surgery using a composite graft compare to traditional methods using the saphenous vein?

  6. Will using a composite graft based on the internal thoracic artery in its original location improve my long-term heart health outcomes compared to other methods?

  7. What is the recovery process like for a CABG surgery using a composite graft, and how does it differ from traditional methods?

  8. Are there any ongoing studies or research that I should be aware of regarding the effectiveness of using composite grafts for CABG surgeries?

  9. Are there any alternative treatment options or techniques that I should consider for my specific heart condition?

  10. What are the potential costs associated with a CABG surgery using a composite graft, and will my insurance cover this procedure?

Reference

Authors: Hwang HY, Kim KB. Journal: Ann Cardiothorac Surg. 2018 Sep;7(5):686-689. doi: 10.21037/acs.2018.06.08. PMID: 30505754