| Background:Although the application of multi-arterial grafting(MAG)and totalarterial grafting(TAG)for coronary artery bypass grafting(CABG)confers improved survival when compared to conventional revascularization with left internal thoracic artery and saphenous vein grafts(LITA+SVG),only bilateral internal thoracic arteries(BITAs),radial artery(RA)and right gastroepiploic artery(GEA)have been used at present.Herein,we assessed the early and median results of the simultaneous application of descending branch of the lateral circumflex femoral artery(DLCFA)and RA in arterial CABG.Methods:Between March 2017 and February 2021,60 patients underwent arterial CABG with the simultaneous utilization of DLCFA and RA in our hospital.Preoperative computed tomographic angiography of DLCFA and Allen’s test of RA were necessary for successful using of the two grafts.The technique was performed in patients(mean age of 51.2±5.0 years)with a longer life expectancy.Clinical data were analysed retrospectively to sum up the surgical experience and results.Results:The mean follow-up was 15.8 months.The survival probability was 100%and the rate was 98.3%for freedom from major adverse cardiac events(MACE)during the follow-up included all patients.TAG was performed in 48.3%of the group.Conclusions;The simultaneous using of DLCFA and RA provides good cardiac event-free survival probabilities.And the procedure is safe,easy and time-saving to harvest the two arterial grafts.Further studies are needed.Objective Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally uni ventricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods Between January 2009 and December 2019,123 patients undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with extracardiac conduitTCPC(EC-TCPC)method,24 cases used intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.40 cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results There were 7 patients in Group 1 and 14 patients in Group 2 required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg was emerged as a predictor for early reoperation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:the distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexist.However,the technique should be altered when the postoperative mP AP was greater than 15 mmHg.Since Favoloro successfully performed coronary artery bypass grafting(CABG)with the saphenous vein in 1968[1],the saphenous vein has been widely used as a graft due to its convenience and sufficient length in clinical practice.But the middle and long term progressive intimal hyperplasia and atherosclerotic plaque formation of saphenous vein[2,3]lead to the stenosis and occlusion of graft,which affects the long-term results.Therefore,in order to ensure the long-term patency rate as well as the surgical effect,the application of arterial grafts is constantly being explored. |
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