Vervoort Dominique, Elbatarny Malak, Rocha Rodolfo, Fremes Stephen E
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A1, Canada.
Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada.
J Clin Med. 2023 Mar 15;12(6):2275. doi: 10.3390/jcm12062275.
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.
缺血性心脏病是全球发病和死亡的主要原因，病情较重或出现症状时可能需要进行冠状动脉血运重建。冠状动脉旁路移植术（CABG）是最常见的心脏外科手术，可采用不同的旁路血管和吻合技术进行。除左胸廓内动脉外，大隐静脉移植物（SVG）是CABG最常用的血管。单支胸廓内动脉和SVG的治疗效果良好，通过新颖的获取技术、保存方法和优化的药物治疗，SVG的长期通畅率可能会提高。然而，越来越多的证据表明动脉移植物具有优越性，尤其是在多支动脉移植（MAG）的形式下。尽管如此，由于技术复杂性和确凿的随机对照试验证据匮乏，MAG的应用仍然有限且存在差异。在此，我们概述了CABG技术、获取方法和吻合类型，以实现完全动脉血运重建并采用MAG。我们还对迄今为止MAG与单支动脉移植的现有证据进行了叙述性总结，并强调了仍存在的差距和问题，这些问题需要进一步研究以阐明MAG在CABG中的作用。
