Ann Thorac Surg 2008;86:1449. doi:10.1016/j.athoracsur.2008.07.082
© 2008 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Jacob Bergsland, MD
Interventional Center, Rikshospitalet, Sognsvannsveien, 0027 Olso, Norway
(Email: nielsb{at}aol.com).
Optimal selection of conduits is important for the prognosis after coronary bypass grafting (CABG). Gastroepiploic artery (GEA) grafts have better long-term patency than saphenous vein grafts [1], but except in Japan, where the authors of this article practice, grafting with the GEA has not gained widespread use. Concerns have been the need to open the abdomen and the lack of a simple preoperative method for evaluation of this conduit. The current article by Kamohara and colleagues [2] describes a reliable method of predicting the quality and size of the GEA by using multidetector computed tomography (MDCT) to screen the vascular system before CABG.
The authors address the important question of whether imaging should be used to assess conduits before CABG. The quality of the saphenous vein is important for long-term graft patency [3], but saphenous veins are usually harvested without assessment by phlebography, venography, or angioscopy [4]. This may result in incisions longer than necessary or the use of a suboptimal vein. Similarly, mammary and radial arteries are usually harvested without using imaging techniques. Angiographic visualization at the time of coronary angiography may assure quality of the mammary arteries and the GEA, but complicates the procedure.
MDCT may image all potential arterial conduits, but cost considerations and increased radiation may be limiting factors for its routine use before CABG, unless MDCT becomes a major tool for imaging of the coronary arteries. Meanwhile, MDCT or magnetic resonance imaging [5] could be used when GEA grafting is contemplated to prevent an unnecessary laparotomy and could possibly increase the use of GEA.
Preoperative imaging of conduits should probably be considered more frequently to make CABG less invasive and more reliable. Whether such imaging should be based on MDCT, magnetic resonance imaging, ultrasound, or traditional angiography remains to be seen.
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References
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- Suma H, Tanabe H, Takahashi A, et al. Twenty years experience with the gastroepiploic artery graft for CABG Circulation 2007;116(11 Suppl):I188-I191.[Medline]
- Kamohara K, Minato N, Minematsu N, et al. Preoperative evaluation of the right gastroepiploic artery on multidetector computed tomography in coronary artery bypass graft surgery Ann Thorac Surg 2008;86:1444-1449.[Abstract/Free Full Text]
- Lajos TZ, Robicsek F, Thubrikar M, Urschel H. Improving patency of coronary conduits "valveless" veins and/or arterial grafts J Card Surg 2007;22:170-177.[Medline]
- Wilson YG, Davies AH, Currie IC, et al. Angioscopy for quality control of saphenous vein during bypass grafting Eur J Vasc Endovasc Surg 1996;11:12-18.[Medline]
- Ladd SC, Debatin JF, Stang A, et al. Whole-body MR vascular screening detects unsuspected concomitant vascular disease in coronary heart disease patients Eur Radiol 2007;17:1035-1045.[Medline]
Related Article
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Preoperative Evaluation of the Right Gastroepiploic Artery on Multidetector Computed Tomography in Coronary Artery Bypass Graft Surgery
- Keiji Kamohara, Naoki Minato, Noritoshi Minematsu, Junji Yunoki, Takeshi Hakuba, Hisashi Satoh, Hiroyuki Morokuma, and Yuichi Takao
Ann. Thorac. Surg. 2008 86: 1444-1449.
[Abstract]
[Full Text]
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