MODERN VIEWS AND APPROACHES TO THE CHOICE OF GRAFTS DURING CORONARY ARTERY BYPASS GRAFTING. PART 2: COMPARATIVE ANALYSIS OF DIFFERENT TYPES OF GRAFTS

It is known that coronary artery bypass grafting is still one of the main method of treatments from the point of increasing survival rates and avoidinig resergions and the risk of repeated interventions for most patients, in particular, in patients with multivessel coronary disease and diabetics. More than 45 years have passed since the first operation of coronary artery bypass grafting, and currently coronary artery bypass grafting is not only the most common operation in cardiovascular surgery, but also the “gold standard” for the treatment of the coronary heart disease. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. And the question of which grafts are more efficient and durable is becoming more and more urgent. The long-term benefit of the internal thoracic artery has long been proven and the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. It is not always possible to achieve complete revascularization with arterial grafts, which requires the use of venous grafts. Unfortunately, the saphenous vein graft does not have the same duration of functioning, which leads to the occurrence of dysfunctions and the development of repeated ischemic events. On the other hand, the radial and internal arteries are exposed to spasm and vulnerable to competitive blood flow In this paper, a detailed analysis of the main types of grafts in coronary surgery is carried out.