Arterial Grafting for Coronary Artery Bypass Surgery PDF
Preview Arterial Grafting for Coronary Artery Bypass Surgery
Guo-WeiHe(Ed.)ArterialGraftingforCoronaryArteryBypassSurgery SecondEdition Guo-Wei He (Ed.) Arterial Grafting for Coronary Artery Bypass Surgery Second Edition ForewordbyDentonA.Cooley,Houston,USA Contributionsby FloydD.Loop,Cleveland,USA GianniD.Angelini,Bristol,UK BruceW.Lytle,Cleveland,USA AntonioM.Calafiore,Torino,Italy JosephF.Sabik,Cleveland,USA ChristopheAcar,Paris,France HendrickB.Barner,St.Louis,USA BrianF.Buxton,Melbourne,Australia MichaelJ.Mack,Dallas,USA JamesTatoulis,Melbourne,Australia HartzellV.Schaff,Rochester,USA HisayoshiSuma,Tokyo,Japan JohnPym,Philadelphia,USA MasashiKomeda,Kyoto,Japan AlfredJ.Tector,Milwaukee,USA AnthonyP.C.Yim,HongKong DavidP.Taggart,Oxford,UK andOtherWorldExperts With148Figuresin205Partsand77Tables Guo-WeiHe(Ed.)ArterialGraftsforCoronaryBypassSurgery FirstpublishedbySpringer-VerlagLtd.,Singapore,1999 ISBN3-540-30083-X Springer-VerlagBerlinHeidelbergNewYork LibraryofCongressControlNumber:2005935948 Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthe materialisconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicrofilmorinanyotherway,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisions oftheGermanCopyrightLawofSeptember9,1965,initscurrentversion,andpermissionfor usemustalwaysbeobtainedfromSpringer-Verlag.Violationsareliableforprosecutionunder theGermanCopyrightLaw. SpringerisapartofSpringerScience+BusinessMedia http://www.springer.com ˇ Springer-VerlagBerlinHeidelberg2006 PrintedinGermany Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutthe applicationofoperativetechniquesandmedicationscontainedinthisbook.Ineveryindividual casetheusermustchecksuchinformationbyconsultingtherelevantliterature. Editor:GabrieleSchröder DeskEditor:StephanieBenko Copy-editing:WSEditorialLtd,Shrewsbury,UK ProductionEditor:JoachimW.Schmidt Coverdesign:eStudioCalamar,Spain Typesetting:FotoSatzPfeiferGmbH,D-82166Gräfelfing Printedonacid-freepaper–24/3150–543210 THEEDITOR: ProfessorGuo-WeiHe,MD,PhD,DSc ClinicalProfessorofSurgery OregonHealthandScienceUniversity(2002–)andDirector, CardiovascularResearch,AlbertStarrAcademicCenterforCardiacSurgery, ProvidenceHeartandVascularInstitute(1994–),Portland,Oregon,USA CardiacSurgeon-in-Chief DepartmentofCardiacSurgeryandDirector, WuhanHeartInstitute,TheCentralHospitalofWuhan,China(2003–) ResearchProfessorofSurgeryandDirector CardiovascularSurgicalResearch, TheChineseUniversityofHongKong,HongKong(2000–) Professor,ChairofCardiothoracicSurgery TheUniversityofHongKong,HongKong(1995–2000) Foreword Dr.CooleyisPresidentandSurgeon-in-Chief,TexasHeartInstitute,andClinical Professor,UniversityofTexasMedicalSchoolatHouston,Houston,Texas,USA Ischemicheartdiseaseistheleadingcauseofdeathintheworldtoday,anditsinci- denceislikelytoincreaseastheaverageageofthepopulationcontinuestorise,par- ticularlyinindustrializednations.Inthe1950s,theprevalenceandseriousnessofis- chemicheartdiseaseandtheadventofeffectivecardiopulmonarybypasstechnology spurredsurgeonstodevelopcoronaryarterybypassgrafting(CABG)procedures. Later,inthe1970s,percutaneouscoronaryinterventionsweredevisedasalessinva- sive alternative to CABG, and the number of these performed annually now sur- passesthatofCABGsurgery.Nonetheless,CABGremainsamongthemostcommon cardiac surgical procedures, with more than 500,000 performed each year in the DentonA.Cooley UnitedStatesalone. For thesereasons, advances in CABG techniques have tremendous potential to savelivesandimprovetheirquality.Thisisparticularlytrueforimprovementsinthe durabilityofarterialconduits,theuseofwhichisthecentralandmosttechnically demandingportionoftheCABGprocedure.Thisbookismeanttobeacomprehen- siveresourceforcardiacsurgeonsconcerningarterialgraftingandgraftmaterialsin CABG. Manyrenownedcardiacsurgeonsandcardiovascularresearchershavecontribut- ed to this volume, which has been compiled by Guo-Wei He, MD, PhD, DSc. Dr.HehaspublishedahugebodyofliteratureaboutarterialgraftinginCABG,and hisextensiveexperiencein,anddeepunderstandingof,thissubjecthasearnedhim globalrecognition.HecurrentlyservesasDirectorofCardiovascularResearchPro- gramsattheChineseUniversityofHongKongandtheProvidenceHeartInstitutein Portland,Oregon,andheisClinicalProfessorofSurgeryattheOregonHealth&Sci- ence University. Additionally, Dr. He directs the Wuhan Heart Institute in China, whereheisalsoChiefofCardiacSurgery. Thefirsteditionofthisbookwaswrittenin1999toprovideadetailedreviewof existingknowledgeaboutthenatureandselectionofgraftmaterialsforCABGand thetechniquesusedtoharvestthemandanastomosethemtothecoronaryarteries. Rapidprogressinthisfieldduringthelast5yearshasstimulatedDr.Hetopublish thisupdatededition.Notonlyhasnewmaterialbeenaddedtotheexistingchapters, buttherearealsonewchaptersonvenousgrafts,reoperativeCABG,andtherecently developedpracticeofinternalthoracicarteryandradialarteryT-grafting. Readerswillfindthisbookvaluablebothasapracticalguideandasastimulusfor further improvement of arterial grafting techniques and technology. I commend Dr.Heandthemanyauthorsofthisvolumeforthediligenceandexpertisetheyhave demonstratedinitscreationandrevision. Houston,Texas,USA DentonA.Cooley Preface “Somebooksaretobetasted,otherstobeswallowed, andsomefewtobechewedanddigested.“ FrancisBacon(1561–1626) “Isn’titapleasuretostudyandpracticewhatyouhavelearned?“ Confucius(551–479b.c.) Coronaryarterydiseaseremainsthemajorcauseofmortalityworldwide.Despite aggressive application of percutaneous coronary interventions, the surgical ap- proach,namelycoronaryarterybypassgrafting(CABG),remainsamajorapproach forthetreatmentofcoronaryarterydisease.Usageofarterialgraftinghasbeenwell acceptedasthemainapproachtoincreasingthelong-termpatencyofthegraftand long-termsurvival.However,theuseofarterialgraftsisnotasimpleissue.Thisisre- flectedbythediversityinpracticeamongmostexperiencedcardiacsurgeonsaround the worldasto thechoice of conduit, thecombineduseof variousarterialgrafts, pedicle versus free grafting, etc. The issue is further complicated by the usage of thesegraftsduringconventionalcardiopulmonarybypassoronbeatinghearts,the usageofminimallyinvasivesurgeryinCABG,and,moreover,bythefactthatmost surgeonsarestillusingveingraftsincombinationwitharterialgrafts.Withallthese Guo-WeiHe concerns,acomprehensivebookonCABGusingarterialgraftshasbecomeessential forcardiacsurgeonsandrelatedprofessionalssuchascardiologists,cardiacanesthe- siologists,nurses,andotheralliedprofessionalsfordailyreference. Thefirsteditionofthisbookwaspublishedin1999bySpringer-Verlag.Sincethen, muchexperiencehasbeenobtainedregardingarterialgraftinginCABG.Theprinci- palroleoftheleftinternalmammaryartery(IMA)asthefirstchoiceofarterialgraft standswithoutargumentandtheuseofalternativearterialgraftshasbecomemore matureinthehandsofmostcardiacsurgeons.However,variousmethodsofusingthe leftIMAincombinationwithalternativegraftsarebeingusedsincetheroleofthelat- terisdefineddifferentlyamongevenmostexperiencedcardiacsurgeons.Forexample, useoftheradialarteryisroutinepracticebysomesurgeonsbutisignoredbyothers. Asimilarattitudeisheldbysurgeonsastotheuseofthegastroepiploicarteryandin- feriorepigastricartery.ThisissueexistsintheuseofthesecondIMA,namelytheright IMA.Inaddition,theuseofcomplexarterialgraftsremainssubjecttodiverseopin- ions.Furthermore,muchattentionhasbeenpaidtothelogicaluseoftheminimally invasivetechnique.Forexample,therolesofminimallyinvasivedirectcoronaryartery bypass(MIDCAB)andport-accesstechnologyhavebeenredefined. This second edition is an effort to provide the reader with the most advanced knowledgeregardingtheissuessuchasthosementionedabovefromworld-renowned experts.Tobestreflectthecurrentstatusofarterialgraftingworldwide,newcontribu- torshavebeeninvitedtowriteintheirareasofexpertise.Iwouldparticularlymention thecontributionbythesenewauthorsandtheircolleaguesinthesecondedition:Dr. BruceLytleandJosephSabikfromtheClevelandClinic;Dr.HendrickBarnerfromSt. Louis;Dr.HartzellSchafffromtheMayoClinic;Dr.AlfredTectorfromMilwaukee;Dr. Matthew Slater from Portland; Dr. Piet Boonstra from The Netherlands; Professor Gianni Angelini, Professor David Taggart, and Dr. Jamie Jeremy from the UK; and ProfessorsMasashiKomeda,MasamiOchi,andTohruAsaifromJapan.Iwouldalso acknowledgethecontributionofmycolleaguesProfessorAnthonyYim,Dr.SongWan, andDr.QinYangattheChineseUniversityofHongKong.Inadditiontoallthecon- tributorsforthefirstedition,theyhavemadethebookmorecomplete. Thesuccessfuluseofarterialgrafts,i.e.,thearterialconduitwithadiameterof around2mm,islargelyrelatedtothemethodofovercomingthevasospasmofthe X Preface graftintheperioperativeperiod.Withamoreadvancedunderstandingofthebasic physiologyandpharmacologyofthearteriesandveinsusedforgrafting,thisedition providesthenewestinformationontheendothelialfunctionandthemethodof overcomingvasospasminthearterialgrafts.Theadvancementofourbasicknowl- edgeofmyocardialprotectionisalsoreflectedinthisedition. Thereareafewchaptersforwhichtheoriginalcontributorsarenotcontactable duetoretirementorotherreasons.Inthesecaseswherenonewcontributorscould beidentified,Ididtherelevantliteraturesearchesandupdatedthechaptermyself. Thesechaptersare„HistologyandComparisonofArterialGraftsUsedforCoronary Surgery,“„SplenicArteryGrafting,“and„UseofSubscapular-ThoracodorsalArtery forCABG.“Thereisnonewliteratureaboutinferiormesentericarterygraftingand Ithereforewroteanupdatenoteforthechapter. ForthechapteronthecomparisonofunilateralandbilateralIMAgrafting,after discussionwiththeoriginalauthor,Irewrotethechapterwithupdatedinformation tobetterreflectthecurrentview. Ontheotherhand,tobestreflecttheuseofveingraftsincombinationwitharteri- algraftsinmostsurgeons’practice,thiseditionalsoincludesachapterontheroleof veingraftsinCABGbymyself,achapterongenetherapyforveingraftdisease,and achapteronthepreventionofveingraftfailure.Theuseofarterialgraftinginreope- rativeCABGisincludedbypresentingthelargeexperiencefromtheClevelandClin- ic.Intheminimallyinvasivetechniqueofarterialgrafting,Dr.MichaelMackhas combinedhisthreechaptersinthefirsteditionintoanewconciseonewithupdated information.TwochaptersonportaccessofCABGhavebeenreducedtooneinorder toreflectthenewtrendinthisarea. Asoneofthemostpressingandcontroversialissuesincoronarysurgerytoday, theindicationsandresultsofcoronaryinterventionandCABGareattractingtheat- tentionofallcardiacsurgeonsandcardiologists.Thesecondeditionthereforein- cludesanewchapteronthecomparisonbetweencoronaryinterventionandCABG. Thiseditionalsohasanaddedsectiononqualitycontrolofarterialgraftingby presentingthemethodofmeasuringthebloodflowinthearterialgraft.Further- more,tobetterreflecttheAmericanexperienceatlargeinarterialgrafting,inaddi- tiontothenewchapterfromClevelandmentionedaboveontheuseofarterialgrafts inreoperativeCABG,theexperienceonT-graftandinternalthoracicartery-radial artery-T-graftfromothercentersisdescribedindetail. Iwouldliketoextendmygreatgratitudetotheoriginalcontributorsofthefirst editionwhoremainsointhesecond.Theseauthorshavemadegreateffortstopro- videupdatestotheirexperienceandhavekeptthebookinstepwiththeadvance- mentofscienceandmedicine.Theyhavemadethebookavaluableadditiontothe referencelibraryofcardiacsurgeons,cardiologists,anesthesiologists,andallother professionalsandscientistsworkingincardiovascularscienceandmedicine. AsImentionedabove,ouraimwiththesecondeditionistomakethisbookone ofthefewtobechewedanddigested,asFrancisBaconsaid,andtomakeitapleasure tostudyandbehelpfulinpractice,asindicatedbyConfucius.Itisuptothereaderto judgewhetherthisgoalhasbeenfulfilled. Finally,IamdeeplyindebtedtoDr.AlbertStarrforhiscontinualsupportanden- couragementtomywork,nottomentionthatIhavebeentheDirectorofCardiovas- cularResearchsince1994attheAlbertStarrAcademicCenterforCardiacSurgery, theProvidenceHeartInstitute,Portland,Oregon.Iamalsoextremelygratefulto Dr.DentonCooleyfortheusefulpersonalcommunicationsandfortheforewordhe warmlywroteforthisedition.ThesecretarialassistanceofMissChing-YanNgis greatlyappreciated. Portland,Oregon,USA ProfessorGuo-WeiHe WuhanandHongKongSAR,China Contents ForewordbyDentonA.Cooley................ VII 4 ClinicalClassificationofArterialGrafts G.-W.He,C.-Q.Yang .................... 31 Preface .................................... IX 4.1 Introduction ............................ 31 4.2 ClinicalClassification .................... 31 I BiologicalCharacteristicsofArterialGrafts References .................................. 34 1 HistologyandComparisonofArterialGrafts UsedforCoronarySurgery II UseofVasodilatorsforArterialGrafts J.A.M.vanSon,F.M.M.Smedts,C.-Q.Yang, inCoronaryBypassSurgery G.-W.He ................................ 3 5 PharmacologicalStudiesandGuidelines 1.1 InternalMammaryArtery ................. 3 fortheUseofVasodilatorsforArterialGrafts 1.2 RightGastroepiploicArtery ................ 7 G.-W.He,C.-Q.Yang .................... 39 1.3 InferiorEpigastricArtery .................. 8 5.1 PharmacologicalStudies .................. 39 1.4 RadialArtery ............................ 9 5.2 FactorsDeterminingtheEffectsofVasodilator 1.5 IntercostalArtery......................... 10 Substances.............................. 42 1.6 Comment................................ 11 5.3 GuidelinesfortheUseofVasodilators References .................................. 14 forArterialGraftsinCABG ............... 44 2 EndothelialFunctionandInteraction References .................................. 44 BetweentheEndotheliumandSmoothMuscle inArterialGrafts III MyocardialProtectionDuringCoronary G.-W.He ................................ 17 BypassSurgeryUsingArterialGrafts 2.1 Endothelium-DerivedRelaxingFactors ...... 17 6 MyocardialManagementinArterial 2.2 Endothelium-DerivedContractingFactors.... 17 Revascularization 2.3 VasoconstrictorsandVasospasminArterial B.S.Allen,G.D.Buckberg ............... 51 Grafts................................... 17 6.1 CardioplegicPrerequisites................. 51 2.4 Vasoconstrictor-StimulatedEDRFRelease 6.2 CardioplegicComposition ................ 52 inArterialGrafts ......................... 19 6.3 BloodCardioplegia ...................... 52 2.5 Endothelium-DependentRelaxation 6.4 OperativeStrategy ....................... 53 andHyperpolarizationinArterialGrafts ..... 20 6.5 CardioplegiaPressure .................... 57 2.6 TheBalanceBetweenEDRFsandEDCFs ..... 21 6.6 RetrogradeCardioplegia .................. 57 References .................................. 22 6.7 SpecificIssueswithallArterialConduits .... 59 3 ClinicalPhysiologyandRelatedBiological 6.8 Reperfusion............................. 59 6.9 TopicalHypothermia ..................... 60 Characteristics G.-W.He ................................ 24 6.10 Conclusions............................. 61 References .................................. 61 3.1 DifferencesinBiologicalCharacteristics BetweenVenousandArterialGrafts ......... 24 7 CardiacProtectionfromtheViewpoint 3.2 AreThereAnyDifferencesAmongArterial ofCoronaryEndothelialFunction Grafts? .................................. 24 Q.Yang,G.-W.He ....................... 63 3.3 BiologicalCharacteristics .................. 25 7.1 PossibleMechanismsUnderlyingtheDamage References .................................. 29 ofCardioplegiaandOrganPreservation onEndothelialFunction .................. 64 XII Contents 7.2 InfluenceofCardioplegicandOrgan 11 SurgicalTechniquesforInternalThoracic PreservationSolutionsonIndividualEDRFs 65 ArteryGrafting 7.3 InfluenceofDifferentComponentsin S.Seevanayagam,B.Buxton........... 97 CardioplegicandOrganPreservation 11.1 Introduction .......................... 97 SolutionsonEndothelialFunction ......... 65 11.2 Anatomy ............................. 97 7.4 EffectofDifferentAdditivestoCardioplegic 11.3 Harvesting ........................... 97 orOrganPreservationSolutionsonEndo- 11.4 Histology............................. 100 thelialFunction ......................... 66 11.5 GoalsofArterialGrafting............... 100 References .................................. 68 11.6 GraftingStrategy ...................... 101 11.7 GraftingTechniques ................... 101 11.8 BeatingHeartBypassSurgery ........... 103 IV PercutaneousCoronaryInterventionsVersus 11.9 LessInvasiveSurgicalTechniques ........ 103 CoronaryArteryBypassSurgery 11.10 Conclusions .......................... 104 8 NeedleorKnife?AComparisonBetween References ................................. 104 PercutaneousCoronaryInterventions(Includ- ingPlainBalloonAngioplastyandCoronary 12 Long-TermResultsofInternalThoracic Stenting)andCoronaryArteryBypassSurgery ArteryGrafting D.J.Drenth,P.W.Boonstra ............. 73 J.F.SabikIII,F.D.Loop................. 105 8.1 Introduction............................ 73 12.1 Introduction .......................... 105 8.2 PercutaneousCoronaryInterventions ...... 73 12.2 History .............................. 105 8.3 CoronaryArteryBypassGrafting .......... 73 12.3 Patency .............................. 105 8.4 PCIVersusCABG........................ 74 12.4 Survival.............................. 107 8.5 DrugElutingStents ...................... 75 12.5 FreedomfromRecurrentIschemicEvents 109 8.6 RevascularizationStrategy ................ 76 12.6 Conclusions .......................... 110 References .................................. 76 References ................................. 110 13 BilateralVersusUnilateralInternalThoracic V ClinicalChoiceofArterialGrafts ArteryinCoronaryBypassGrafting 9 ConsiderationsintheChoiceofArterial E.Berreklouw,G.-W.He .............. 113 Grafts 13.1 Introduction .......................... 113 G.-W.He ............................... 81 13.2 History .............................. 113 9.1 GeneralConditionofthePatient ........... 82 13.3 IndicationsforUseofBilateralITAs ...... 113 9.2 BiologicalCharacteristics ................. 82 13.4 RelativeContraindications .............. 114 9.3 AnatomyoftheCoronaryArtery........... 84 13.5 EarlyMortality........................ 114 9.4 VesselMatchBetweentheGraftandthe 13.6 MyocardialInfarction .................. 115 CoronaryArtery ........................ 84 13.7 LateResults........................... 119 9.5 TechnicalConsiderations ................. 84 13.8 PostoperativeFlowMeasurements........ 123 9.6 Conclusion ............................. 84 13.9 LateECG-StressTesting ................ 123 References .................................. 84 13.10 LateBloodFlowStudies ................ 123 13.11 LatePatencyRates ..................... 124 13.12 Conclusions .......................... 125 VI InternalThoracicArteryGrafting References ................................. 125 10 HistoryofInternalThoracicArteryGrafting andAlternativeArterialGrafts 14 Left-SidedMyocardialRevascularization M.Durairaj,B.Buxton................. 89 withBilateralSkeletonizedInternal 10.1 EarlyDirectArterialRevascularization ThoracicArtery Techniques ............................. 90 R.Mohr,A.Kramer .................. 130 10.2 CoronaryArteriography.................. 91 14.1 Introduction .......................... 130 10.3 SaphenousVeinCoronaryArteryBypass.... 92 14.2 HarvestingandPreparationofthe 10.4 InternalThoracicArteryGrafting.......... 92 SkeletonizedITA ...................... 131 10.5 ExpandedUseoftheITAGraft ............ 92 14.3 StrategiesofLeft-SidedArterial 10.6 AlternativeArterialGrafts ................ 93 Revascularization...................... 132 10.7 ITAGraftsandMinimallyInvasiveCoronary 14.4 ClinicalResults........................ 137 ArteryBypassGrafting ................... 93 14.5 Comments............................ 137 10.8 TheFuture ............................. 93 References ................................. 138 References .................................. 94
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