Analysis Of Early And Mid-term Clinical Effects Of Total Arterial Coronary Artery Bypass Grafting

Background:Coronary artery bypass grafting(CABG)is an effective surgical treatment for revascularization of severe coronary artery disease.The patency of the grafts is an important factor that determines the surgical effect,especially the long-term effect.At present,the most commonly used coronary revascularization scheme is the left internal thoracic artery combined with the great saphenous vein for CABG.However,the rate of mid-to-long-term restenosis of venous grafts is relatively high.In order to improve the patency of the grafts,the concept of total arterial revascularization(TAR)was proposed.Recentlly,total arterial CABG is gradually implement in clinical.Objective:To explore the early and mid-term clinical effects of total arterial CABG,and summarize the surgical methods and clinical experience,in order to provide clinical evidence for the development of total arterial CABG.Methods:From September 2018 to September 2020,90 patients(88 males,2females,age of 8.63±7.84 years,rage 40-76 years)underwent total arterial CABG in the Department of Cardiovascular Surgery of Jilin University Second Hospital.We collected preoperative basic clinical data,intraoperative coronary vascular anastomosis strategy,postoperative vital signs data,coronary CTA patency,postoperative complications and follow-up,etc.,to evaluate the early and mid-term clinical effects of total arterial CABG.Results:The average number of grafts was(3.09±0.89).85 underwent off-pump total arterial coronary artery bypass(OPCABG),and 5 underwent on-pump beating heart CABG.6 used left internal thoracic artery(LITA),6 used bilateral internal thoracic artery,78 used bilateral internal mammary artery + left radial artery.A total of 90 left anterior descending branches(LAD),53 diagonal branches(DA),67 left circumflex branches(LCX),64 right coronary arteries(RCA),and 274 bypasses were treated.The rate of no transfusion in perioperative was 96.67%(87/90),the 30-day mortality rate was 1.11%(1/90),the stroke incidence was 1.11%(1/90),and the incidence of perioperative low cardiac output syndrome was 8.89%(8/90),the rate of intro-aortic balloon pump(IABP)nwas 7.78%(7/90),the incidence of sternal malunion was1.11%(1/90),and the numbness of the left upper limb was 5.13%(4 /78),no need for revascularization,no pericardial tamponade,no secondary thoracotomy of bleeding,no complications such as liver and kidney insufficiency,and no left upper limb dysfunction.Coronary artery CTA before discharge showed that grafts was slightly narrowed in 1 case,without grafts occlusion,the patency was 97.78%(89/90).The follow-up time was postoperative 6 months,1 year,and 2 years.89 patients completed the 6-month follow-up.CTA examination showed 2 cases of grafting vessel stenosis and no bridging vessel occlusion.The patency was 97.75%(87/89).There were no death,no recurrence of angina pectoris,and no revascularization again,no numbness and dysfunction of the left upper limb,sternum healed well.80 cases completed the 1-year follow-up.Coronary artery CTA showed 2 cases of grafting vessel stenosis and no bridging vessel occlusion.The 1-year patency was 97.50%(78/80).There was no death,recurrence of angina pectoris,and no recurrence.Revascularization,good sternum healing,no numbness and dysfunction of the left upper limb.38 patients completed the 2-year follow-up.Coronary CTA showed 2cases of bridging vessel stenosis and no bridging vessel occlusion.One of this has recurrence of angina pectoris.The 2 years patency was 94.74%(36/38).There were no death.There was no revascularization,good sternum healing,numbness and dysfunction of the left upper limb.Conclusion:Total arterial CABG has a low rate of restenosis,high patency rate,low mortality,no serious complications,and satisfactory early and mid-term clinical effects.Therefore,total arterial CABG is safe and feasible,and it’s a surgical program worth promoting.