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Total Arterial Coronary Artery Bypass Surgery
Presentations
Total arterial coronary bypass surgery
Where arteries only are used as bypass grafts without any vein grafts.
PowerPoint Presentation (5 MB) Adobe PDF (1.5 MB)
New techniques have rapidly changed practice at the Royal Melbourne Hospital. There have been a number of reasons why change has occurred so quickly and to such a large extent. The concept that arteries are likely to remain disease free for longer than vein grafts was mostly based on the data from studies in the 1980's showing very high late patency of the left internal mammary artery (LIMA) when compared to vein.
However, change in practice occurred long before the late patency of radial artery is known and it was related to an impression of lower risk of death from surgery as well as being a more flexible conduit to use. More "efficient" techniques of surgery using the radial artery were then rapidly adopted which lead to the great majority of patients no longer receiving any vein graft at all.
Use of arteries only, rather than vein grafts is one of the corner stones of these changes. In this large unit, we use arteries only in about 80% of all patients with improved safety as a result. The key has been the use of radial artery which is harvested from the forearm and provides arteries to use with very few complications.
Use of arteries in a more efficient way will also be detailed and the various techniques will have graphical and text explanations. These may be found in the Techniques section. These techniques appear to improve the safety of the surgery. Use of composite grafting techniques, it is possible to use arteries only in up to 99% of patients undergoing coronary artery bypass surgery.
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