Clinical Effect Of Total Arterialized Coronary Artery Bypass Grafting Under On-pump And Off-pump

Objective:To analyze the recent clinical effects of Total arterial bypass grafting(TACAB)under on-pump and off-pump.To compare the two surgical methods and perioperative management experience,and to provide clinical evidence for the use of left internal mammary artery(LIMA)combined with bilateral radial artery(RA)coronary artery bypass grafting.Methods:To review the clinical data of 37 patients who received LIMA combined with RA bypass from June 2020 to November 2021 in Qianfoshan Hospital of Shandong Province,including preoperative basic clinical data,intraoperative bridge vessel acquisition and anastomosis,postoperative management and complication management.All patients received computed tomography angiography(CTA)3 months after surgery to evaluate the patency rate of bridge vessels and the incidence of adverse cardiovascular events.A total of 114 bridges were anastomosed,and 54(47.37%)were on-pump coronary artery bypass grafting(ONCAB).A total of 60 cases(52.63%)of off-pump coronary artery bypass grafting(OPCAB)were performed with 5.00 anastomoses and 3.00 distal anastomoses.LIMA was anastomosed to the area dominated by the anterior descending or diagonal branches of the anterior wall of the left ventricle in all patients.Proximal RA was anastomosed end-to-end to ascending aortic root,while distal RA was most frequently anastomosed in ascending aorta-radial artery-diagonal branch(AO-RA-D,23cases,20.18%).Ascending aorta-radial artery-posterior descending branch(AO-RA-PDA,19cases,16.67%),the remaining anastomosis was ascending aortic-radial artery-obtuse marginal branch(AO-RA-OM,17cases,14.91%),aortic-radial artery-posterior branch of left ventricle(AO-RA-PLA,9 cases,7.89%),ascending aorta-radial arteryintermediate ramus(AO-RA-Ramus,3 cases,2.63%),aortic-radial artery-anterior descending(AO-RA-LAD,3 constituents,2.63%),ascending aorta-radial artery-right coronary artery(AO-RA-RCA,2 cases,1.75%),Aortic-radial artery-circumflex artery(AO-RA-LCX,2 cases,1.75%).Results:The incidence of atrial fibrillation in ONCAB group was significantly higher than that in OPCAB group(50%VS 9.52%,P<0.05),and transient ventricular arrhythmia occurred in 6 patients(16.22%).Sixteen patients(43.24%)had respiratory complications.Transaminase increased more than 3 times in 5 cases(13.51%)with transient impaired liver function.Three patients(8.11%)had temporary renal impairment,and serum creatinine increased>1.5 times from baseline within 7 days;Eleven cases(29.73%)had complications of upper limbs and forearms.3 months after surgery,all bridge vessels were unobstructed well,and the left ventricular end diastolic diameter(LVEDD)in ONCAB and OPCAB groups was improved compared with that before surgery.49.00±5.16 VS 47.88±4.73、P=0.525,50.81 ±5.61 VS 49.71 ±2.78、P=0.427,respectively.The cardiac function of the two groups was improved compared with that before surgery,54.88±6.53 VS 56.50±5.88、P=0.465,56.33±8.71 VS 57.76±5.96、P=0.538,respectively,without statistical significance.5 cases(13.5%)showed symptoms of angina pectoris,and 3 cases(8.11%)remained numbness and discomfort of upper limbs and forearms.Conclusions:LIMA+RA bypass under cardiopulmonary bypass or off-cardiopulmonary bypass has satisfactory clinical results in recent years,which is worthy of promotion and application.Attention should be paid to the early prevention of atrial fibrillation after ONCAB.Neuroprotection should be paid attention to when obtaining radial artery.It is very important to regularly use anticonvulsive drugs in perioperative and postoperative period.