multiple arterial graft cabg
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Multiple arterial graft cabgTRANSCRIPT
““Multiple Multiple Arterial Graft Arterial Graft
CABG”CABG”Where do we Where do we
stand?stand?
Mohammad ShihataMohammad Shihata
CABGCABG
• The most performed operation in the developed world.
• Enjoying a re-established role as a gold standard for severe CAD.
• The best treatment for LM and 3 vessel CAD.
Changing DemographicsChanging Demographics
• Aging population: > 20% over the age of 70 by 2030.
• CAD combined with other cardiac pathology (e.g. / Aortic stenosis ) will be more frequent.
• Treatment standards for the elderly need to be defined better.
LIMA to LAD + RSVGs is a very LIMA to LAD + RSVGs is a very good operationgood operation
but ....
can we make it better ?can we make it better ?
Why MAG?Why MAG?
Literature Literature ReviewReview
Probability of saphenous vein graft patency
Age GroupAge Group 5y5y 10y10y
50 - 5950 - 59 93%93% 78%78%
60 – 6960 – 69 92%92% 80%80%
70 – 7970 – 79 94%94% 76%76%
>80>80 80%80% 58%58%
University of Melbourne Database 1986 – 2007;University of Melbourne Database 1986 – 2007;18,588 CABG patients18,588 CABG patients
Buxton B, et al . 23rd EACTS , 2009
3000 patients. At 18 months the portion of occluded or severely diseased SVG was 47% and 38% for endoscopic and open harvesting respectively.
Over 3000 reports 1978 – 1999; 10 analyzed.Over 3000 reports 1978 – 1999; 10 analyzed.
Adjusted 12 y survivalAdjusted 12 y survival
1984 - 1987 ; 1087 patients
Composite Outcome:Composite Outcome:All cause death, non – fatal MI,All cause death, non – fatal MI, PCI, Redo CABGPCI, Redo CABG
Limitations to MAGLimitations to MAG
Patient Factors:• Obese Diabetics (BIMA)• Severe COPD (BIMA)• Immunosuppressants
Technical Factors:• Inadequate IMA or Radial (uncommon)• Large target with moderate stenosis
MAG still stubbornly low!!!MAG still stubbornly low!!!
In North America & UK
• 95% receive a single IMA• < 20% receive 2 arterial grafts (more radial
than BIMA)• STS Database < 5% receive BIMA• < 3% receive 3 arterial grafts.
142 consultant adult cardiac surgeons; 90 replies. 142 consultant adult cardiac surgeons; 90 replies.