Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease

Rafaeli I.R.; Pankov A.N.; Getazheev K.V.; Zhuravlev A.S.; Chernysheva I.E.; Semitko S.P.

doi:https://doi.org/10.17116/kardio202417061646

Rafaeli I.R.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-0495-2645

Pankov A.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-2681-4243

Getazheev K.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0001-5193-0556

Zhuravlev A.S.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-9130-707X

Chernysheva I.E.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1268-5145

Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease

Authors:

Rafaeli I.R., Pankov A.N., Getazheev K.V., Zhuravlev A.S., Chernysheva I.E., Semitko S.P.

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Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(6): 646‑650

DOI: 10.17116/kardio202417061646

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To cite this article:

Rafaeli IR, Pankov AN, Getazheev KV, Zhuravlev AS, Chernysheva IE, Semitko SP. Left anterior descending artery and diagonal branch bypass in multiple-vessel coronary artery disease. Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(6):646‑650. (In Russ.)
https://doi.org/10.17116/kardio202417061646

Подписка 2026 Кардиология и сердечно-сосудистая хирургия (Russian Journal of Cardiology and Cardiovascular Surgery)

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OBJECTIVE

To determine the effect of diagonal branch bypass grafting on patency of internal mammary artery (IMA) anastomosed with the left anterior descending artery (LAD) depending on Medina classification and severity of stenosis.

MATERIAL AND METHODS

A retrospective study included 87 patients who underwent LAD bypass with IMA and diagonal branch bypass grafting with venous conduit. We estimated angiography data in 60±9 months after surgery. Patency of IMA conduits was 90.8%, venous grafts to diagonal branch — 82.8%.

RESULTS

Significant (>70%) stenosis between diagonal branch and distal LAD prevents competitive blood flow for IMA. Patency rate was 95.8%, 100% and 94.7% for Medina 1:1:1, 1:0:1 and 0:1:1, respectively. In Medina 1:1:0 and no significant stenosis between diagonal branch and LAD, IMA patency was only 60%. In Medina 1:0:0, IMA dysfunction was observed in 75% of cases regardless of severity of proximal LAD stenosis.

CONCLUSION

No significant stenosis between LAD and diagonal branch leads to iatrogenic competitive blood flow in LAD and subsequent IMA dysfunction. In such situations, simultaneous diagonal branch revascularization is not advisable.

Keywords:

competitive blood flow

coronary artery bypass grafting

internal mammary artery

venous conduit

Medina classification

Authors:

Rafaeli I.R.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-0495-2645

Pankov A.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-2681-4243

Getazheev K.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0001-5193-0556

Zhuravlev A.S.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-9130-707X

Chernysheva I.E.

Sechenov First Moscow State Medical University

Semitko S.P.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-1268-5145

Received:

30.04.2023

Accepted:

08.08.2023

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References:

Grover FL, Johnson RR, Marshall G, Hammermeister KE. Impact of mammary grafts on coronary bypass operative mortality and morbidity. Department of Veteran Affairs Cardiac Surgeons. Ann Thorac Surg. 1994;57:559-569.
Dabel RJ, Goss JR, Maynard C, Aldea GS. The effect of left internal mammary artery utilization on short-term outcomes after coronary revascularization. Ann Thorac Surg. 2003;76:464-470.
Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg. 1985;89:248-258.
Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary artery graft on 10-year survival and other cardiac events. N Engl J Med. 1986;314:1-6.
Zeff RH, Kongtahworn C, Iannone LA, et al. Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. Ann Thorac Surg. 1988;45:533-536.
Boylan MJ, Lytle BW, Loop FD, et al. Surgical treatment of isolated left anterior descending coronary stenosis: comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. J Thorac Cardiovasc Surg. 1994;107:657-662.
Cameron AA, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol. 1995;25:188-192.
Cameron A, Davis KB, Green G, Schaff HV. Coronary bypass surgery with internal-thoracic-artery grafts-effects on survival over a 15-year period. N Engl J Med. 1996;334:216-220.
Fumiyuki Otsuka, Kazuyuki Yahagi, Kenichi Sakakura, Renu Virmani. Why is the mammary artery so special and what protects it from atherosclerosis? Ann Cardiothorac Surg. 2013;2(4):519-526. https://doi.org/10.3978/j.issn.2225-319X.2013.07.06
Spaan JAE, Piek JJ, Hoffman JIE, Siebes M. Physiological basis of clinically used coronary hemodynamic indices. Circulation. 2006;113(3):446-455.
Zhao X, Liu Y, Li L, Wang W, Xie J, Zhao Z. Hemodynamics of the string phenomenon in the internal thoracic artery grafted to the left anterior descending artery with moderate stenosis. J Biomech. 2016;49(7):983-991. https://doi.org/10.1016/j.jbiomech.2015.11.044
Hayashi Y, Maekawa A, Sawaki S, Tokoro M, Yanagisawa J, Ozeki T, Usui A, Ito T. Long-term patency of on- and off-pump coronary artery bypass grafting with bilateral internal thoracic arteries: the significance of late string sign development in the off-pump technique. Interact Cardiovasc Thorac Surg. 2017;25(5):799-805. https://doi.org/10.1093/icvts/ivx214
Rafaeli IR, Pankov AN, Savelov EA, et al. Free right internal mammary artery graft in bilateral internal mammary artery grafting. Kardiologiya i Serdechno-Sosudistaya Khirurgiya. 2018;11(4):26-30. (In Russ.). https://doi.org/10.17116/kardio201811426
Gharibeh L, Ferrari G, Ouimet M, Grau JB. Conduits’ Biology Regulates the Outcomes of Coronary Artery Bypass Grafting. JACC Basic Transl Sci. 2021;6(4):388-396. https://doi.org/10.1016/j.jacbts.2020.11.015
Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59(2):183.
Hayward PA, Zhu YY, Nguyen TT, Hare DL, Buxton BF. Should all moderate coronary lesions be grafted during primary coronary bypass surgery? An analysis of progression of native vessel disease during a randomized trial of conduits. J Thorac Cardiovasc Surg. 2013;145(1):140-148.
Paulo Roberto B. Evora, Livia Arcêncio, André Schmidt, Alfredo José Rodrigues. Prophylactic Left Internal Mammary Artery Graft In Mildly-Stenosed Coronary Lesions. Still An Open Discussion. Arquivos Brasileiros de Cardiologia. 2016. https://doi.org/10.5935/abc.20160032
Rami Akhrass, Faisal G. Bakaeen Figures Intraoperative graft patency validation: Friend or foe? JTCVS Tech. 2021;7:131-137. https://doi.org/10.1016/j.xjtc.2020.12.040
Rafaeli TR, Pankov AN, Rodionov AL, et al. The effect of coronary artery stenosis on function of mammary shunts after direct myocardial revascularization surgery. Bulletin of the Dagestan State Medical Academy. 2016;4:45-46. (In Russ.).