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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.

Original publication

DOI

10.1161/circulationaha.117.027597

Type

Journal article

Journal

Circulation

Publication Date

10/2017

Volume

136

Pages

1749 - 1764

Addresses

From Department of Cardiothoracic Surgery, @Weill Cornell Medicine, New York (M.G., A.D.F., L.B.O., R.T., L.N.G.); Department of Medicine and Department of Cardiovascular Surgery, John Radcliffe Hospital, University of Oxford, UK (C.A., D.P.T.); Bristol Heart Institute, University of Bristol, School of Clinical Sciences, UK (U.B.); Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Canada (S.D., S.F.); University "G. D'Annunzio," Chieti, Italy (G.D.G., D.M.); Division of Cardiac Surgery, Ottawa Heart Institute, Canada (D.G., J.G.); TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China (G.-W.H.); Department of Pharmacology, Catholic University School of Medicine, Rome, Italy (C.P.); and Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai,New York (J.P.). mfg9004@med.cornell.edu.

Keywords

ATLANTIC (Arterial Grafting International Consortium) Alliance, Coronary Vessels, Humans, Graft Occlusion, Vascular, Coronary Artery Bypass, Risk Factors, Coronary Artery Disease