Distal Anastomosis Support for Coronary Artery Bypass Grafting: A New Surgical Technique and Current Outcomes

Yang, Jian; Wang, Liangshan; Li, Haitao; Liu, Changcheng; Li, Bo; Li, Hui; Li, Rui; Gu, Chengxiong

doi:10.1016/j.hlc.2016.10.018

Cited by 3 publications

(8 citation statements)

References 23 publications

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“…One study has pointed out that a new surgical technique, distal anastomosis support system, could effectively improve mid-term patency of SVG-PDA, especially for the patients with endarterectomy. 29 The most likely mechanism is that distal anastomosis support system, fixed onto the heart beside the anastomosis on the PDA, could protect the SVG from crushing between the inferior wall of heart and diaphragm to improve the SVG-PDA patency. In this experiment, I selectively anastomosed the distal end of sequential SVG to the RCA using end-to-side anastomosis.…”

Section: Discussionmentioning

confidence: 99%

The main trunk of RCA may be the best choice of sequential vein graft distal end-to-side anastomosis

Wang

et al. 2021

Perfusion

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Objective: The purpose of this study was to investigate the effect of different anastomotic positions on the early patency of the distal end-to-side anastomosis of sequential saphenous vein grafts (SVG) in off-pump coronary artery bypass grafting (OPCAB). Methods: A total of 259 patients who underwent OPCAB between August 2014 and August 2019 and presented for coronary computed tomography angiography (CCTA) to evaluate graft patency at 1 year post-OPCAB were analyzed. There are two kinds of distal end-to-side anastomosis of SVG, to posterior descending artery (PDA) and main trunk of right coronary artery (RCA). In all, 1044 distal coronary anastomoses on 518 grafts which included 180 left internal mammary artery (LIMA) grafts, individual 79 SVG and 259 sequential SVG were assessed using CCTA. The blood flow (BF), pulsatility index (PI), and patency of every anastomosis were recorded. Besides, comprehensive data of SV-PDA and SV-RCA patients was also compared. Results: The mean BF of SV-RCA was significantly higher than that of SV-PDA (31.71 ± 18.60 vs 22.62 ± 14.48, p = 0.001), and the PI value of SV-RCA was significantly lower than that of SV-PDA (2.57 ± 1.17 vs 3.50 ± 1.69, p = 0.001). The patency of RCA system was significantly lower than that of the LAD and the left circumflex system (79.25% vs 90.13%, 90.23% respectively, p = 0.001). In sequential SVG, the patency of SV-PDA was significantly lower than that of SV-RCA (74.01% vs 86.59%, p = 0.001). Although, there was no significant difference in left ventricular ejective fraction, the left ventricular end-diastolic diameter (LVDd) in SV-PDA group was significantly larger than that in SV-RCA (52.67 ± 8.72 mm vs 47.34 ± 7.55, p = 0.001). In addition, the target vessel diameter in SV-PDA group was smaller than that in SV-RCA group (1.52 ± 0.41 mm vs 3.17 ± 0.88 mm, p = 0.001). Conclusion: The early patency of sequential SVG end to RCA after OPCAB is generally superior to that of to PDA, especially for patients with large LVDd.

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Section: Discussionmentioning

confidence: 99%

The main trunk of RCA may be the best choice of sequential vein graft distal end-to-side anastomosis

Wang

et al. 2021

Perfusion

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“…Producing the DAS in OPCABG + CE + DAS group after getting favorable graft patency measured by Transit time flow measurement (MediStim, Oslo, Norway) was quite simple as we described previously. 13 Firstly, we folded a 2-cm × 2-cm square Dacron patch into a cylinder, of which the diameter slightly bigger than the size of SVG, and then fixed by a silk suture. Then, an auto pericardium patch was used to cover the Dacron patch and sutured with a 6-0 polypropylene suture.…”

Section: Operation Techniquementioning

confidence: 99%

“…9,11,12 The anatomic spatial relationship between the PDA and diaphragm may account for this phenomenon. 13 Our previous study had demonstrated that concomitant DAS protecting the anastomosis on the PDA from deformation caused by diaphragm could improve the mid-term patency of SVG-PDA in isolated CABG. In this study, 13 we applied the DAS for patients with PDA-CE and investigated the effect of DAS on the mid-term graft patency of SVG-PDA.…”

Section: Introductionmentioning

confidence: 97%

Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery

Wang

Liu

et al. 2021

Perfusion

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Background: The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency. Methods: Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, n = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, n = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG. Results: There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842–60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453–9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081–0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139–0.812, p = 0.015) were significant protective factors. Conclusions: Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.

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“…Согласно данным литературы [28,31,[33][34][35], окклюзия шунта, обусловленная тромбозом, происходит в срок от первых суток после выполнения вмешательства и до 1 мес послеоперационного периода. В последних исследованиях [29,32,36] показано, что основными причинами ранней (до 1 мес) и среднеотдаленной (до 1 года) дисфункции аутовенозных шунтов являются тромбоз шунта, гиперплазия интимы и технические ошибки наложения анастомоза, приводящими к тромбозу графта.…”

Section: важность применения операционного микроскопа в коронарной хиunclassified

“…Многочисленные данные [28,[37][38][39][40][41][42] подтверждают, что хирургическая техника и прецизионность выполнения анастомозов значительно влияют на проходимость шунта на ранних сроках после КШ. В том числе это подтверждают самые последние исследования в этой области [29,32,36]. В ряде сообщений [42][43][44][45] показано, что использование микрохирургических инструментов и шовного материала, а также уменьшение количества вколов при формировании анастомозов снижают травмирование интимы и частоту острого тромбоза трансплантата.…”

Section: важность применения операционного микроскопа в коронарной хиunclassified

Microsurgery of coronary arteries using an operating microscope

Альсов

Осипов

Акчурин

et al. 2019

Khir. Z. im. N.I. Pirogova

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Представлен мировой опыт использования операционного микроскопа при коронарном шунтировании. Приведены данные, свидетельствующие о важной роли применения операционного микроскопа и микрохирургической техники для выполнения коронарных анастомозов. Благодаря высокому оптическому увеличению формирование коронарных анастомозов стало более точным, что положительно сказывается на послеоперационной проходимости шунтов. Ключевые слова: операционный микроскоп, микрохирургическая техника, коронарное шунтирование, проходимость шунтов.

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Distal Anastomosis Support for Coronary Artery Bypass Grafting: A New Surgical Technique and Current Outcomes

Cited by 3 publications

References 23 publications

The main trunk of RCA may be the best choice of sequential vein graft distal end-to-side anastomosis

The main trunk of RCA may be the best choice of sequential vein graft distal end-to-side anastomosis

Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery

Microsurgery of coronary arteries using an operating microscope

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