Expertise and skill with more than 3000 cases experience in 20 years

Since its establishment in 1998, our hospital has performed over 3,000 cases of coronary artery bypass grafting (including combined surgeries for valve disease, etc.).

In the past 10 years, we have performed 1,097 cases of isolated coronary artery bypass grafting. The mortality rate for emergency surgeries was 8%, while the mortality rate for planned surgeries was 1%. Building upon our extensive experience, we continue to strive for safer and more reliable coronary artery bypass surgeries.

CABG:

When the coronary arteries that supply blood to the heart become narrowed or blocked, it can lead to myocardial infarction and angina. For cases with mild severity or certain lesion types, it is possible to use catheter-based procedures such as balloon angioplasty or stenting to open up the narrowed areas. However, for severe cases, cases where catheter-based procedures are difficult, cases with recurrent episodes, or cases with urgency, surgery is necessary.

During the surgery, bypass grafts are performed using normal peripheral arteries located beyond the site of the lesion in the coronary arteries. The bypass grafts utilize the internal thoracic artery, the artery in the upper arm (radial artery), and the vein in the lower limb (great saphenous vein).

Selection of Bypass Grafts:

For bypassing the coronary arteries, grafts that closely resemble the patient’s own blood vessels are used. While artificial grafts for bypass purposes are under development, autologous vessels are preferred due to their better patency rates. The following are the options for bypass grafts:

1. Internal thoracic artery: Located behind the chest wall, this artery is the primary choice. There are two internal thoracic arteries, and both can be used or only one (usually the left). They have excellent patency rates.

2. Great saphenous vein: This is a vein on the surface of the leg. It is commonly used as it is easy to harvest and provides a long graft. However, there is a risk of approximately 30% occlusion after 10 years, although recent advances in harvesting techniques and postoperative medication have improved its durability.

3. Radial artery: This artery is located in the forearm. It is expected to have good durability as an arterial graft, although there is no significant difference compared to venous grafts. It is used when the great saphenous vein is unavailable due to conditions such as lower limb varicose veins.

4. Gastroepiploic artery: This artery runs around the stomach and can be harvested and used as a graft. It is considered to have good durability as an arterial graft, but it has the disadvantage of low blood flow. Additionally, it requires an abdominal incision.

Full Artery Grafts vs. Artery and Vein Grafts:

This is a topic frequently discussed in cardiac surgery societies. Full artery grafts are said to have better durability, while artery and vein grafts are considered to have poorer durability. However, there are reports suggesting differences and no differences in long-term mortality and reoperation rates. While there are influential surgeons in the society who strongly recommend full artery grafts, in the real world, artery and vein grafts are used in over 80% of cases and the trend is increasing. Reasons for this include the time-consuming nature of artery harvest, higher rate of chest wound infections, and length limitations. Artery and vein grafts can be considered as a safe and easily performed surgery. Furthermore, advancements in catheter-based treatments have resulted in favorable long-term outcomes.

At our hospital, our principle is to perform multi-branch bypass grafting using the left internal thoracic artery and a single great saphen