Background
In coronary artery bypass grafting (CABG) for haemodialysis patients, arteriovenous
fistula can reduce blood flow from the internal mammary artery (IMA) graft. The purpose
of this study was to delineate the rationale of ipsilateral IMA grafting to the arteriovenous
fistula by assessing graft flow and patency.
Method
The clinical records of 139 haemodialysis patients who underwent off-pump CABG, including
IMA grafting to the left anterior descending artery (LAD) between April 2007 and December
2018, were retrospectively reviewed. Clinical outcomes and transit-time flowmetry
results of IMA to LAD bypass grafts during off-pump CABG and postoperative angiography
were examined.
Results
An ipsilateral IMA to the arteriovenous fistula (Ipsi-IMA) was used in 89 patients,
and a contralateral IMA to the arteriovenous fistula (Contra-IMA) was used in 50 patients
and no hospital deaths occurred. The mean graft flow and angiographic patency rate
did not differ between the Ipsi-IMA and Contra-IMA groups. In patients with 51 to
90% stenosis of LAD, there was no significant difference in the mean graft flow. In
comparison, in the patients with 91 to 100% stenosis of LAD, the mean graft flow in
the Ipsi-IMA group was significantly lower than that in the Contra-IMA group (p=0.03).
Kaplan-Meier analyses showed a 5-year survival rate of 57.6% for Ipsi-IMA and 64.8%
for Contra-IMA (p=0.47).
Conclusions
In the revascularisation of the LAD, the graft patency rate of the Ipsi-IMA was not
inferior to that of the Contra-IMA. However, when the LAD has 91 to 100% stenosis,
a Contra-IMA to arteriovenous fistula may be beneficial in terms of sufficient flow
capacity.
Keywords
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Article info
Publication history
Published online: July 13, 2022
Accepted:
June 4,
2022
Received in revised form:
May 28,
2022
Received:
January 16,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
