Comparative Research Of The Patency Rates Of Individual And Sequential Anastomose On Saphenous Vein Grafts In Off-pump Coronary Artery Bypass Grafting

Objective Off-pump coronary artery bypass grafting(OPCAB)was performed on patients with multiple sections and locations of coronary artery stenosis disease whose myocardial blood supply cannot be effectively improved by medications or percutaneous coronary intervention(PCI).The intraoperative blood flow and the postoperative patency rates of individual and sequential saphenous vein grafts(SVGs)were comparatively analyzed.Analysis on the safety and superiority of OPCAB for coronary artery bypass graft surgery was conducted and the clinical outcomes and the effectiveness of sequential anastomose technique on OPCAB was summarized and evaluated.Methods The clinical data of 126 patients who received OPCAB with individual or sequential SVGs between January 2005 and December 2016 in Anhui Provincial Hospital or Chizhou People's Hospital affiliated to Anhui Medical University were collected.86 patients were male and 40 were female,with a mean age of 64.9±7.5 years(45 years to 78 years).After systemic use of heparin,OPCAB procedure was performed,with an end-to-side anastomose connecting the left internal mammary artery(LIMA)with the distal stenosis section of left anterior descending artery.According to anastomose technique of SVGs,all the patients were categorized into individual group or sequential group.For 50 cases of individual grafts,the distal ends of several SVGs were anastomosed to the distal end of the target vessels and the proximal end of SVGs were anastomosed to the ascending aorta.For 76 cases of sequential grafts,one SVG was applied,with its proximal end anastomosed to the ascending aorta,its middle part anastomosed to other target vessels and its distal end anastomosed to the final target vessels of a better condition.Immediate blood supply was made when each anastomose was completed.All the patients of the two groups underwent 64-slice multidetector spiral computed tomography angiography(64-MSCTA)examinations at follow-up and the patency of 290 anastomoses on 171 SVGs and 126 LIMA grafts was analyzed.The clinical data of two groups,including 1)age,sex,follow-up duration,operation surgeons and postoperative angina;2)the patency of LIMA grafts;3)the blood flow of proximal anastomoses on SVGs;4)the overall patency rates of individual and sequential SVGs;5)the patency rates of different locations for SVGs;and 6)the patency rates in different coronary artery systems.Results 1.There was no significant difference between the two groups in terms of gender,age,follow-up duration or the technique of surgeons(all P >0.05).There was no difference for the occurrence of postoperative angina(P >0.05).2.The patency rates of the LIMA grafts were similar between the sequential group and the individual group,as well as the completeness of patency(P >0.05).3.There was significant difference for the blood flow of proximal section on the double sequential,triple sequential and individual SVGs.The blood flow of proximal anastomose on double and triple sequential SVGs was higher than on individual SVGs.There was significant difference for proximal blood flow and overall patency rates between the sequential group and individual group(P <0.05).4.The overall patency rate of sequential grafts was significantly higher than of individual grafts(P <0.05).5.There was a significant difference in the patency rates among the middle anastomoses in sequential grafts,the distal anastomoses in sequential grafts and the distal anastomoses in individual grafts(P < 0.001).The patency rate of middle anastomoses was higher than the distal anastomoses in sequential grafts(P =0.022)and the distal anastomoses in individual grafts(P <0.001).The patency rate of distal anastomoses in sequential grafts was higher than in individual grafts(P =0.045).6.There was no significant difference for the overall patency rates in different coronary systems,for neither the individual(P =0.450)nor the sequential grafting groups(P =0.144).Conclusion The patency of sequential SVGs was significantly better than of individual SVGs after OPCAB.When performing sequential anastomosis grafting with median chest incision under general anesthesia,the LIMA was anastomosed to the left anterior descending artery firstly,and then one saphenous vein was anastomosed to other target vessels sequentially,with the distal end placed at the target vessels of better conditions.The surgical procedure is effective,reliable and safe,and worthy of clinical application and promotion due to its superiority compared to individual grafting technique.Further study is warranted to shed light on its long-term patency.