| ObjectiveTo compare the mid-term patency rates of sequential and single saphenous vein graft(SVG)after off-pump coronary artery bypass(OPCAB)and to evaluate the security and superiority of proximal-anastomosis-first sequential anastomosis technique in OPCAB.MethodsBased on the criteria of inclusion and exclusion strictly,retrospective analysis a total of 418 patients with MVD underwent primary isolated OPCAB procedure with sequential and single SVG between march 2015 to march 2016.According to whether using sequential-SVG,they were divided into two group:(1)230 cases of sequential-SVG group,34 cases with two distalis anastomtics,176 cases with three distalis anastomotics,and 20 cases with four distalis anastomotics,a total of 676 anastomosis,contain 216 middle anastomotic and 230 distalis anastomotics;(2)188 cases of single-SVG group.Patients with sequential SVG were divided into two groups according to different surgical procedures,i.e.proximal-anastomosis-first sequential technique group(POPCAB,n=146)and the distal-anastomosis-first sequential fashion group(DOPCAB,n=84).Perioperative parameters of the two groups were compared.The heart performance parameters including cardiac output(CO),cardiac index(CI),systemic vascular resistance(SVR),pulmonary vascular resistance(PVR).All patients underwent multislice computed tomographic angiography(MS-64CTA)at 1 months to 2 years(13.8±11.6)months after operation.A total of 906 anastomosis of 418 SVG were evaluated.Compare the flow and pulsatility index of SVG,the total patency rate of SVG and anastomosis and the patency in different parts of sequential SVG and The incidence of MACE was compared between the sequential-SVG group and the single-SVG group.ResultsThere were no significant differences in age,sex,previous history of myocardial infarction and percutaneous coronary stent implantation(PCI)or comorbidities including hypertension,diabetes mellitus and number of grafts between the two groups with sequential SVG.Conversion from off-pump to on-pump because of malignant arrhythmia and unstable hemodynamics occurred less in the POPCAB group(1.4% vs.7.1%,P = 0.005).The parameters including CO(0.25±0.07 vs.0.12±0.03,P<0.001),CI(0.13±0.03 vs.0.06±0.02,P<0.001),SVR(106.20±9.46 vs.55.70±11.09,P<0.001),PVR(11.2±2.09 vs.16.60±4.69,P = 0.004)improved more significantly in the POPCAB group.The CK-MB(47.20±8.02 vs.57.30±11.06,P = 0.031)and N-terminal pro-brain natriuretic peptide(NT-proBNP)level(1945.60±296.06 vs.2727.90±775.33,P = 0.012)at the point of postoperative 24 hours were lower in POPCAB group.The length of staying in ICU(25.00±3.65 vs.29.10±4.66,P = 0.042)and hospital(13.50±1.64 vs.15.10±11.67,P = 0.045)was shorter for the POPCAB group.The proximal blood flow of the sequential SVG was higher than that of the single SVG(45.2 ± 4.6 vs 26.8 ± 7.2,P = 0.014).The total patency rate of sequential anastomosis was higher than that of a single anastomosis(91.4% vs.94.5%,P = 0.034).The incidence of MACE after OPCAB was not statistically significant between sequential-SVG group and single-SVG group(3.4% vs.3.2%,P = 0.871).The ratio of angina was not statistically significant(4.3% vs.3.7%,P = 0.748).ConclusionThe proximal-anastomosis-first sequential bypass grafting technique provides an improved safety approach of OPCAB to achieve complete revascularization;The patency rate of sequential SVG in postoperative OPCAB are more satisfactory than that of the single SVG and it didn’t increase the MACE incidence rate.In conclusion,the proximal-anastomosis-first sequential bypass grafting technique improve the surgical treatment of patients with multivessel coronary artery disease. |
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