Comparative Analysis Of Early Prognosis Of Left Internal Mammary Artery Combined With Radial Artery Or Great Saphenous Vein Bypass

Objective With the rise of the concept of total artery bypass,the combination of left internal mammary artery(left internal mammary artery,LIMA)and radial artery(radial artery,RA)graft has been widely used in clinical practice and achieved an ideal therapeutic effect.The aim of this study was to compare the surgical experience and early prognosis of LIMA combined with RA and LIMA combined with SVG.Methods From August 2016 to May 2018 in the first affiliated Hospital of Guangxi Medical University,72 patients with multi-vessel coronary artery disease were retrospectively analyzed.Among them,The number of patients who had received RA bypass(LIMA+ RA was used in 9 patients,LIMA +RA +SVG was used in16 patients)and SVG was 25 patients and 47 patients,Off-pump bypass was used in all cases.within the 72 patients in the first affiliated Hospital of Guangxi Medical University,after operation respectively,Sixty-one patients were followed upfor an average of 25 months.The follow-up data included coronary CT,coronary angiography and cardiovascular events such as myocardial infarction,cerebral infarction,and so on.Of which LIMA 31 branches,RA 22 branches,SVG 45 branches.Results The average age of the patients was 53 ±5.5years.The age of RA group was lower than that of SVG group: 49 ±4.5 vs 55 ±6.3,and p< 0.0001.the proportion of men in RA group was higher: 92% vs 76.%,but the difference is not statistically significant,p=0.106.There was significant difference in cardiac function(NYHA)between RA group and SVG group: RA vs SVG,3.1±0.59 vs 3.4±0.35;p=0.008.In terms of the number of grafts,RA group had 25 branches of LIMA,34 branches of RA and 20 branches of SVG.The average number of grafts was 3.12 ±0.33,there were 47 branches of LIMA and 113 branches of SVG(19sequential grafts)in SVG group,the average number was 3.40 ±0.49,p =0.012.The monitoring time in CSICU was 3 ±2.8 days in RA group and 3 ±1.9 days in SVG group,the average postoperative monitoring time in CSICU of all patients was 3±2.2 days and the average hospitalization time was 24 ±17 days.There were no complications such as myocardial infarction and cerebral infarction during hospitalization.There was no significant difference in the overall survival rate and(MACE)of major adverse cardiovascular events between RA group and SVG group in the first and second year after operation.Imaging examination showed that all LIMA was unobstructed and the overall patency rate of RA was not significantly differentfrom that of the SVG group:RA 95.4% and 93.3%,p=0.730.In the RA group,14 patients underwent LIMA +RA +SVG bypass grafting,the results showed that the RA was unobstructed,while the SVG bridge was slightly narrowed in 2 cases(14.2%).Conclusion there is no significant difference in early survival rate between RA combined with LIMA and SVG combined with LIMA bypass grafting,and the early patency rate of radial artery bridge vessel is the same as that of great saphenous vein.But the trend of stenosis of great saphenous vein graft is more obvious.