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Advances in Coronary Surgery Using Arterial Conduits
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Advances in Coronary Surgery Using Arterial Conduits

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 12209

Special Issue Editor

Prof. Dr. Alistair Royse

E-Mail Website
Guest Editor
1. Department of Surgery, University of Melbourne, Melbourne, VIC 3050 Australia
2. Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
Interests: Total arterial revascularisation; TAR; Arterial coronary bypass; Radial artery; RA; Coronary surgery

Special Issue Information

Dear Colleagues,

Increased or exclusive use of arterial conduits in coronary surgery is widely viewed as beneficial for improved survival as well as the avoidance of recurrent symptoms or heart failure. However, the practice of coronary surgery has not changed internationally, with approximately 95% of cases still involving the use of a single arterial conduit and supplementary saphenous vein grafts.

This Special Issue of the Journal of Clinical Medicine will cover important evidence related to:

  1. Late survival outcomes of total arterial revascularization (TAR) or multiarterial grafting (MAG) compared to traditional single arterial and vein grafting
  2. Late occurrence of major adverse events with TAR or MAG compared to traditional grafting methods
  3. The use of TAR and MAG in the elderly
  4. Angiographic outcomes for arterial compared to venous conduits
  5. Reconstruction technique options for achieving TAR and MAG
  6. Statistical methods for analysing large coronary surgery datasets

Prof. Dr. Alistair Royse
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • total arterial
  • multiarterial
  • TAR
  • MAG
  • SAG
  • patency

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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13 pages, 1441 KiB  
Article
Long-Term Survival of Multiple Versus Single Arterial Coronary Bypass Grafting in Elderly Patients
by Justin Ren, Colin Royse, Nilesh Srivastav, Oscar Lu and Alistair Royse
J. Clin. Med. 2023, 12(7), 2594; https://doi.org/10.3390/jcm12072594 - 30 Mar 2023
Cited by 4 | Viewed by 2281
Abstract
Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative [...] Read more.
Multiple arterial grafting (MAG) utilizes more than one arterial graft with any additional grafts being saphenous vein grafts (SVG). It remains an infrequently used coronary surgical revascularization technique, especially in elderly patients. Our study aims to evaluate the age-related association with the relative outcomes of multiple versus single arterial grafting (SAG). The Australian and New Zealand national registry was used to identify adult patients undergoing primary isolated CABG with at least two grafts. Exclusion criteria included reoperations, concomitant or previous cardiac surgery, and the absence of arterial grafting. Propensity score matching was used to match patient groups. The primary outcome was all-cause late mortality and the secondary outcomes were 30-day mortality and 30-day hospital readmission. We selected 69,624 eligible patients with a mean (standard deviation) age of 65.0 (10.2) years old. Matching between MAG and SAG generated 16,882 pairs of patients < 70 years old and 10,921 pairs of patients ≥ 70 years old. At a median [interquartile range] follow-up duration of 5.9 [3.2–9.6] years, MAG was associated with significantly reduced mortality compared to SAG (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.68–0.78; p < 0.001) in the younger subgroup as well as the elderly subgroup (HR, 0.84; 95% CI, 0.79–0.88; p < 0.001). In conclusion, MAG offers a survival benefit over SAG, in both younger and elderly patients. Full article
(This article belongs to the Special Issue Advances in Coronary Surgery Using Arterial Conduits)
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Review

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13 pages, 2785 KiB  
Review
Late Clinical Outcomes of Total Arterial Revascularization or Multiple Arterial Grafting Compared to Conventional Single Arterial with Saphenous Vein Grafting for Coronary Surgery
by Justin Ren, Colin Royse and Alistair Royse
J. Clin. Med. 2023, 12(7), 2516; https://doi.org/10.3390/jcm12072516 - 27 Mar 2023
Cited by 4 | Viewed by 2017
Abstract
Coronary surgery provides better long-term outcomes than percutaneous coronary intervention. Conventional practice is to use a single arterial conduit supplemented by saphenous vein grafts. The use of multiple arterial revascularization (MAG), or exclusive arterial revascularization (TAR), however, is reported as having improved late [...] Read more.
Coronary surgery provides better long-term outcomes than percutaneous coronary intervention. Conventional practice is to use a single arterial conduit supplemented by saphenous vein grafts. The use of multiple arterial revascularization (MAG), or exclusive arterial revascularization (TAR), however, is reported as having improved late survival. Survival is a surrogate for graft failure that may lead to premature death, and improved survival reflects fewer graft failures in the non-conventional strategy groups. The reasons for not using MAG or TAR may be due to perceived technical difficulties, a lack of definitive large-scale randomized evidence, a lack of confidence in arterial conduits, or resources or time constraints. Most people consider radial artery (RA) grafting to be new, with use representing approximately 2–5% worldwide, despite select centers reporting routine use in most patients for decades with improved results. In conclusion, the current body of evidence supports more extensive use of total and multiple arterial revascularization procedures in the absence of contraindications. Full article
(This article belongs to the Special Issue Advances in Coronary Surgery Using Arterial Conduits)
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13 pages, 755 KiB  
Review
Reconstruction Technique Options for Achieving Total Arterial Revascularization and Multiple Arterial Grafting
by Dominique Vervoort, Malak Elbatarny, Rodolfo Rocha and Stephen E. Fremes
J. Clin. Med. 2023, 12(6), 2275; https://doi.org/10.3390/jcm12062275 - 15 Mar 2023
Viewed by 2351
Abstract
Ischemic heart disease is the leading cause of morbidity and mortality worldwide and may require coronary revascularization when more severe or symptomatic. Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure and can be performed with different bypass conduits and [...] Read more.
Ischemic heart disease is the leading cause of morbidity and mortality worldwide and may require coronary revascularization when more severe or symptomatic. Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure and can be performed with different bypass conduits and anastomotic techniques. Saphenous vein grafts (SVGs) are the most frequently used conduits for CABG, in addition to the left internal thoracic artery. Outcomes with a single internal thoracic artery and SVGs are favorable, and the long-term patency of SVGs may be improved through novel harvesting techniques, preservation methods, and optimal medical therapy. However, increasing evidence points towards the superiority of arterial grafts, especially in the form of multiple arterial grafting (MAG). Nevertheless, the uptake of MAG remains limited and variable, both as a result of technical complexity and a scarcity of conclusive randomized controlled trial evidence. Here, we present an overview of CABG techniques, harvesting methods, and anastomosis types to achieve total arterial revascularization and adopt MAG. We further narratively summarize the available evidence for MAG versus single arterial grafting to date and highlight remaining gaps and questions that require further study to elucidate the role of MAG in CABG. Full article
(This article belongs to the Special Issue Advances in Coronary Surgery Using Arterial Conduits)
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22 pages, 2627 KiB  
Review
Angiographic Outcomes for Arterial and Venous Conduits Used in CABG
by Arnaldo Dimagli, Giovanni Soletti, Jr., Lamia Harik, Roberto Perezgrovas Olaria, Gianmarco Cancelli, Kevin R. An, Talal Alzghari, Charles Mack and Mario Gaudino
J. Clin. Med. 2023, 12(5), 2022; https://doi.org/10.3390/jcm12052022 - 3 Mar 2023
Cited by 7 | Viewed by 2652
Abstract
Coronary artery bypass grafting is the most commonly performed cardiac surgical procedure. Conduit selection is crucial to achieving early optimal outcomes, with graft patency being likely the main driver to long-term survival. We present a review of current evidence on the patency of [...] Read more.
Coronary artery bypass grafting is the most commonly performed cardiac surgical procedure. Conduit selection is crucial to achieving early optimal outcomes, with graft patency being likely the main driver to long-term survival. We present a review of current evidence on the patency of arterial and venous bypass conduits and of differences in angiographic outcomes. Full article
(This article belongs to the Special Issue Advances in Coronary Surgery Using Arterial Conduits)
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Other

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9 pages, 2465 KiB  
Perspective
Defining the Role of Anaortic Coronary Artery Bypass Grafting
by Fabio Ramponi, Michael Seco and Michael P. Vallely
J. Clin. Med. 2023, 12(14), 4697; https://doi.org/10.3390/jcm12144697 - 14 Jul 2023
Cited by 2 | Viewed by 2005
Abstract
As the population ages and co-morbidities become more prevalent, the complexity of patients presenting for coronary artery bypass surgery is increasing. Cardiopulmonary bypass and aortic cross-clamping in these patients carry increased risk and, indeed, in some patients, with ascending aortic disease, the risks [...] Read more.
As the population ages and co-morbidities become more prevalent, the complexity of patients presenting for coronary artery bypass surgery is increasing. Cardiopulmonary bypass and aortic cross-clamping in these patients carry increased risk and, indeed, in some patients, with ascending aortic disease, the risks are prohibitive. Total-arterial anaortic coronary artery surgery is a technique that provides complete surgical coronary artery revascularization without cardiopulmonary bypass and without manipulating the ascending aorta. The technique essentially eliminates the risk of cerebral embolization of aortic atheroma and aortic injury. Anaortic techniques are an essential skillset for coronary artery surgery centers treating higher-risk patients. Full article
(This article belongs to the Special Issue Advances in Coronary Surgery Using Arterial Conduits)
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