Roundtable Discussion: Total Arterial Revascularization

excellent review.

I think contra-indication to use of double IMAs must be depicted as a combo-package..For example Insulin dependent Diabetics and a lady with fragile sternum..or a history of moderate COAD ( 50% reversible) with and Insulin dendent Diabetes and so on.. Wish new guide line should include and/or restrict the number of relative contra-indications to be considered for selection of a patient for double IMA grafting.

The outcome of Coronary artery by pass operation depends on many other factors factors in addition to the type and quality of the Conduits.They are disease factors, patient's factors,Surgeons factors and conduit factors. The total arterial revascularization is a must for patients with poor quality veins irrespective of the patient's age.When consider total arterial grafts, the surgeon has to consider quality of the target, the diameter of the target vessel , the Runoff.There is no point in using good quality good size Arterial graft on a small target,a Poor target,a target with poor runoff and a target with diffused distal vessel disease.The long term out come of CABG will be determined by the disease factors. But, not by the quality or types of the conduits.Rate of blood flow in a vessel (Conduit) directly proportional to the Pressure gradient, Fourth power of the radius and Viscosity of the blood.It is inversly proportional to the length of the conduit.Also the quality of distal and proximal or Aortic anastomoses is much more important than the coduits. The Surgeon has to ensure perfect apposition of endothelial surfaces to prevent anastomotic failures.

The outcome of Coronary artery by pass operation depends on many other factors in addition to the type and quality of the Conduits.They are disease factors, patient's factors,Surgeon's factors and conduit's factors. The total arterial revascularization is a must for patients with poor quality veins irrespective of the patient's age.When consider total arterial grafts, the surgeon has to consider quality of the target, the diameter of the target vessel , the Runoff.There is no point in using good quality good size Arterial graft on a small target,a Poor target,a target with poor runoff and a target with diffused distal vessel disease.The long term out come of CABG will be determined by the disease factors. But, not by the quality or types of the conduits.Rate of blood flow in a vessel (Conduit) directly proportional to the Pressure gradient and Fourth power of the radius It is inversly proportional to the length of the conduit.Also the quality of distal and proximal or Aortic anastomoses is much more important than the coduits. The Surgeon has to ensure perfect apposition of endothelial surfaces to prevent anastomotic failures.I do NOT BELIEVE So called "Arterial graft spasm" .It is pure anastomotic failure.

A v good discussion