Our Summary

This study looked at the success of grafts in heart surgery, specifically how well they were functioning (a term known as ‘patency’). The researchers used CT scans to evaluate this, and also looked at what could influence the average flow of blood through the graft during the operation (the ‘mean graft flow’ or MGF), and whether this could predict if the graft would stop working early on.

The study involved 148 patients, all operated on by the same surgeon, using artery and vein grafts. The researchers checked how well the grafts were working around 11 weeks after the operation. They found that 5.2% of grafts had stopped working, with vein grafts slightly more likely to fail than artery grafts.

They found that women had lower MGF in both types of grafts. They also found that the MGF was positively associated with the diameter of the vessel receiving the graft, and negatively associated with the pulsatility index (a measure of the variation in blood flow).

MGF was found to be a key factor in predicting graft failure, even when other factors like the patient’s EuroSCORE-II (a measure of surgical risk), pulsatility index, graft size, and graft type were considered. The researchers identified MGF levels for artery and vein grafts that were good at predicting early graft failure.

The study concludes that the MGF is influenced by the size of the coronary artery, the patient’s gender, and the type of graft used. The MGF can therefore be used to predict early graft patency. The study also found that modern heart bypass surgery has a low rate of early graft failure when ’transit time flow measurement’ is used to monitor the operation.

FAQs

  1. What is the graft occlusion rate following coronary artery bypass surgery?
  2. How does gender influence the mean graft flow (MGF) in both arterial and venous grafts during coronary artery bypass surgery?
  3. What factors were found to influence MGF absolute values in coronary artery bypass surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about coronary artery bypass is to ensure that they have regular follow-up appointments and tests to monitor the patency of their grafts. Intraoperative mean graft flow (MGF) can be a reliable predictor of early graft occlusion, so it is important for patients to pay attention to their MGF values and discuss them with their healthcare provider. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help improve the overall success of the bypass surgery.

Suitable For

Patients who are typically recommended for coronary artery bypass surgery are those with significant coronary artery disease that cannot be managed effectively with medications or other interventions. This includes patients with multiple blockages in their coronary arteries, severe narrowing of the arteries, or those at high risk for a heart attack or other cardiovascular events. Additionally, patients who have not responded well to previous interventions such as angioplasty or stenting may also be candidates for coronary artery bypass surgery.

Timeline

Before coronary artery bypass surgery, a patient may experience symptoms of coronary artery disease such as chest pain, shortness of breath, and fatigue. They may undergo diagnostic tests such as angiography to determine the extent of blockages in their coronary arteries.

During the surgery, the patient will be put under general anesthesia, and the surgeon will harvest arterial and/or venous grafts to bypass the blocked arteries. The grafts are then sewn onto the coronary arteries to create new pathways for blood flow to the heart muscle.

After the surgery, the patient will be monitored in the intensive care unit and then transferred to a regular hospital room for recovery. They will undergo rehabilitation and lifestyle changes to promote heart health and prevent future blockages.

In the weeks following surgery, the patient may undergo follow-up tests such as computed tomography to assess the patency of the grafts. It is important to monitor the flow of blood through the grafts to detect any potential issues early on.

Overall, modern-era coronary artery bypass surgery has a low rate of early graft failure when intraoperative graft flow measurements are used to ensure optimal blood flow to the heart muscle. Proper monitoring and follow-up care are essential for long-term success and improved quality of life for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about coronary artery bypass include:

  1. How will my graft patency be evaluated after the surgery?
  2. What factors can affect the success of my grafts, such as gender, vessel size, or graft type?
  3. Will intraoperative mean graft flow be measured during my surgery, and how does this impact the likelihood of graft occlusion?
  4. What is the typical rate of graft occlusion for patients undergoing coronary artery bypass surgery?
  5. How will my individual risk factors, such as EuroSCORE-II or pulsatility index, be taken into account in determining the success of my grafts?
  6. What are the potential benefits of using computed tomography angiography to evaluate graft patency post-surgery?
  7. Are there specific thresholds for mean graft flow that indicate a higher likelihood of graft occlusion, and how will this information be used in my case?

Reference

Authors: D’Alessio A, Akoumianakis I, Kelion A, Terentes-Printzios D, Lucking A, Thomas S, Verdichizzo D, Keiralla A, Antoniades C, Krasopoulos G. Journal: Interact Cardiovasc Thorac Surg. 2022 Jun 1;34(6):974-981. doi: 10.1093/icvts/ivab298. PMID: 34718571