Objective:To review our current understanding of the epidemiology and pathogenesis of vein graft failure (VGF), give an overview of current preventive and interventional measures, and explore strategies that may improve vein graft patency.Background:VGF and progression of native coronary artery dise

Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery: Pathophysiology, Management, and Future Directions

Background— Off-pump coronary bypass surgery has become a widely used technique during recent years. However, limited data are available with regard to 1-year patency of bypass grafts implanted on the beating heart in unselected consecutive bypass surgery candidates. The aim of this study was to compare 1-year angiographic patency of bypass grafts done on the beating heart (off pump) with those done classically (on pump). Methods and Results— The PRAGUE-4 trial randomized 400 consecutive nonselected cardiac surgery candidates into group A (on pump; n=192) and group B (off pump; n=208). One-year follow-up coronary angiography was done in 255 patients. The arterial graft patency after 1 year was 91% in both groups. Saphenous graft patency was 59% (on pump) versus 49% (off pump; P=NS). Saphenous graft patency per patient was lower in the off-pump group: 0.7 patent anastomosis per patient versus 1.1 patent anastomosis in the on-pump group (P<0.01). There were 46% on-pump patients with all grafts patent versus...

One-Year Coronary Bypass Graft Patency A Randomized Comparison Between Off-Pump and On-Pump Surgery Angiographic Results of the PRAGUE-4 Trial

Sinus of Valsalva aneurysm (SOVA), a congenital or acquired cardiac defect that is present in roughly 0.09% of the general population, often presents as an incidental finding during cardiac imaging. Although an echocardiogram is the standard imaging technique for such findings, cardiac computed tomography angiography (CCTA) has been increasingly utilized. If SOVA is diagnosed, CCTA is also a useful test for patients who are at low to intermediate risk for coronary artery disease (CAD) prior to surgical repair. CCTA can accurately rule out CAD, obviating the need for invasive angiography in most cases, which may be more risky in SOVA patients because their coronaries may be more difficult to engage and their aortic root may be more prone to injury. Although surgery has previously been the treatment of choice, transcatheter techniques have added to the spectrum of nonsurgical alternatives for repair. We report here 4 incidental SOVA cases and review the current literature.

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Sinus of Valsalva Aneurysms: Review of the Literature and an Update on Management

Myths and truths of pulsatile and nonpulsatile perfusion during acute and chronic cardiac support.

https://www.annalsthoracicsurgery.org/article/S0003-4975(06)00375-4/pdf

Incomplete Circle of Willis and Right Axillary Artery Perfusion

Objective: The reported experience with sinus of Valsalva aneurysms (SVAs) is limited. Our approach to this subset of patients and an algorithm-dependent classification are presented. Methods: Between 1985 and 2000, 53 patients (mean age: 24 ^ 12; range 4‐60) underwent repair for ruptured (64%) or non-ruptured (36%) SVA. Associated lesions were present in 21 patients; VSD in 18, moderate to severe aortic insufficiency in five, aortic stenosis in four (two subaortic membrane and one bicuspid valve), PDA in two, mitral insufficiency in one, tetralogy of Fallot in one and endocarditis in one. Operative procedures included simple or Teflon pledgetted direct suturing (31 cases; 58%), patch repair (21 cases; 40%), and stentless porcine bioprosthetic aortic root replacement in a case with extensive involvement and aortic root distortion (2%). Concomitant procedures were VSD repair in 18 patients, aortic valve replacement in four, aortic valve resuspension in three, subaortic membrane resection in two, PDA ligation in two, mitral annuloplasty in one and total correction in one. Results: Early mortality was 1.9%. A permanent pacemaker was inserted in one patient due to complete heart block. The survivors were followed up for 8.2 ^ 5 years (range: 21 days to 15 years). There were three reoperations due to suture dehiscence; patch repair was undertaken in these patients with no further unfavorable consequences. All patients were in NYHA Class I or II as of their last follow-up. Conclusions: Repair of SVA can be performed with an acceptably low operative risk and a good symptom-free long-term outcome expectation. Echocardiography provides all the necessary details for diagnosis. Dual exposure/patch repair strategy is advocated in the ruptured cases. q 2001 Elsevier Science B.V. All rights reserved.

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Approach to sinus of Valsalva aneurysms: a review of 53 cases.

Objectives: The long-term patency rates for individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits are angiographically compared; the impact of native coronary vessel characteristics is investigated. Methods: A total of 875 distal coronary anastomoses on 500 SVGs were assessed in 430 patients at an average of 5.8 ^ 3 years after a coronary revascularization procedure. Results: The patency rates of sequential conduits were markedly higher than those of individual ones (82 vs. 68%, Pa 0:0005). Also, the anastomoses on the sequential conduits had better patency (75 vs. 68%, Pa 0:03). This difference was even more pronounced in coronary arteries of poor quality and small (,1.5 mm) diameter (57 vs. 28% for the sequential grafts and individual grafts, respectively, Pa 0:001). Also, when the most distally located coronary artery on a sequential graft was of poor run-off, the patency rate for the entire conduit was considerably low (42.5%). Conclusions: The patency of a sequential vein graft conduit is generally better than that of an individual one, especially for poor run-off coronary vessels, provided that the most distally located anastomosis is done on a good coronary artery in terms of quality and diameter. Using a minimal length of conduits is another advantage. However, failure of a single sequential conduit jeopardizes all the anastomoses along that graft segment. Besides, sequential grafting is technically more demanding, and the technical expertise in performing a sequential anastomosis is probably among the important determinants of short- and long-term patency. q 2001 Elsevier Science B.V. All rights reserved.

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Long-term patency of sequential and individual saphenous vein coronary bypass grafts.

Aortic arch repair with right brachial artery perfusion.

Objective: Different closure techniques (linear vs. circular), as well as the efficacy of revascularization in the left ventricular aneurysm repair, with regard to immediate and mid-term results, were assessed and factors having influence on the early mortality and morbidity and survival were analyzed. Method: Between January 1991 and November 1996, 248 patients underwent surgical repair for postischemic left ventricular aneurysm. A total of 26 of them were female (10.5%). Linear closure was employed in 121 patients (48.8 %) and circular (patch endoaneurysmorraphy) closure in 127 (51.2%). Coronary revascularization was added in 203 (81.9%) cases. Patients were followed for an average follow-up time of 39.3 months. Results: Early mortality rate was 6% (15 patients). The difference in mortality rate by the repair method was not statistically significant (8.3% in the linear closure group and 3.9% in the circular closure group, P0.15). Absence of preoperative angina pectoris (P 0.029), dyspnea as the presenting symptom, a preoperative left ventricular segmental wall motion scoring of 14 or greater, a cardiopulmonary bypass duration exceedin g2h( P0.004), an aortic clamping time exceedin g1h( P 0.026) were associated with early mortality. Concomitant coronary revascularization had no effect on early mortality. However, low cardiac output state was less frequent in patients with concomitant coronary revascularization (P0.022). Functional status improved in both groups. Follow-up extending to 81st month revealed no difference in survival between the groups (84% for linear closure group and 92% in circular closure group, including operative mortality, P0.12). However, functional status improvement was better in the patients who underwent circular repair (P0.0077). Revascularization appeared as having no important influence on both survival and functional status. A preoperative left ventricular segmental wall motion scoring of 14 or greater was associated with a higher incidence of early mortality, low cardiac output syndrome and poor long-term survival. Conclusion: Left ventricular aneurysm repair is an important therapeutic intervention and can be performed with reliable results, regardless of repair method, either linear or circular. Long term results revealed better functional status in circular repair group. Concomitant coronary revascularization reduced the incidence of low cardiac output state. Performance of the unaffected regions of myocardium was found to be an important determinant of both early and late outcome. © 1998 Elsevier Science B.V.

Left ventricular aneurysm repair: an assessment of surgical treatment modalities

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Erol Şener

Papers

Approach to sinus of Valsalva aneurysms: a review of 53 cases.

Long-term patency of sequential and individual saphenous vein coronary bypass grafts.

Aortic arch repair with right brachial artery perfusion.

Left ventricular aneurysm repair: an assessment of surgical treatment modalities

Risk factors associated with development of atrial fibrillation early after coronary artery bypass grafting.