TY - JOUR
T1 - Mechanisms, consequences, and prevention of coronary graft failure
AU - Gaudino, Mario Fulvio Luigi
AU - Antoniades, Charalambos
AU - Benedetto, Umberto
AU - Deb, Saswata
AU - Di Franco, Antonino
AU - Di Giammarco, Gabriele
AU - Fremes, Stephen
AU - Glineur, David
AU - Grau, Juan
AU - He, Guo-Wei
AU - Marinelli, Daniele
AU - Ohmes, Lucas B.
AU - Patrono, Carlo
AU - Puskas, John
AU - Tranbaugh, Robert
AU - Girardi, Leonard N.
AU - Taggart, David P.
PY - 2017
Y1 - 2017
N2 - Graft failure occurs in a sizeable proportion of coronary artery bypass conduits. We herein review relevant current evidence to give an overview of the incidence, pathophysiology, and clinical consequences of this multifactorial phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are different mechanisms associated with graft failure. Intrinsic morphological and functional features of the bypass conduits play a role in determining failure. Similarly, characteristics of the target coronary vessel, such as the severity of stenosis, the diameter, the extent of atherosclerotic burden, and previous endovascular interventions, are important determinants of graft outcome and must be taken into consideration at the time of surgery. Technical factors, such as the method used to harvest the conduits, the vasodilatory protocol, the storage solution, and the anastomotic technique, also play a major role in determining graft success. Furthermore, systemic atherosclerotic risk factors, such as age, sex, diabetes mellitus, hypertension, and dyslipidemia, have been variably associated with graft failure. The failure of a coronary graft is not always correlated with adverse clinical events, which vary according to the type, location, and reason for failed graft. Intraoperative flow verification and secondary prevention using antiplatelet and lipid-lowering agents can help reducing the incidence of graft failure.
AB - Graft failure occurs in a sizeable proportion of coronary artery bypass conduits. We herein review relevant current evidence to give an overview of the incidence, pathophysiology, and clinical consequences of this multifactorial phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are different mechanisms associated with graft failure. Intrinsic morphological and functional features of the bypass conduits play a role in determining failure. Similarly, characteristics of the target coronary vessel, such as the severity of stenosis, the diameter, the extent of atherosclerotic burden, and previous endovascular interventions, are important determinants of graft outcome and must be taken into consideration at the time of surgery. Technical factors, such as the method used to harvest the conduits, the vasodilatory protocol, the storage solution, and the anastomotic technique, also play a major role in determining graft success. Furthermore, systemic atherosclerotic risk factors, such as age, sex, diabetes mellitus, hypertension, and dyslipidemia, have been variably associated with graft failure. The failure of a coronary graft is not always correlated with adverse clinical events, which vary according to the type, location, and reason for failed graft. Intraoperative flow verification and secondary prevention using antiplatelet and lipid-lowering agents can help reducing the incidence of graft failure.
KW - CABG
KW - Coronary Artery Bypass
KW - Coronary Artery Disease
KW - Coronary Vessels
KW - Graft Occlusion, Vascular
KW - Graft failure
KW - Humans
KW - Myocardial revascularization
KW - Risk Factors
KW - CABG
KW - Coronary Artery Bypass
KW - Coronary Artery Disease
KW - Coronary Vessels
KW - Graft Occlusion, Vascular
KW - Graft failure
KW - Humans
KW - Myocardial revascularization
KW - Risk Factors
UR - http://hdl.handle.net/10807/170708
U2 - 10.1161/CIRCULATIONAHA.117.027597
DO - 10.1161/CIRCULATIONAHA.117.027597
M3 - Article
SN - 0009-7322
VL - 136
SP - 1749
EP - 1764
JO - Circulation
JF - Circulation
ER -