Side-to-side Anastomosis of Distal End of Sequential Vein Grafts to Small Target Arteries in Coronary Artery Bypass Grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIHai-tao ,  GUCheng-xiong , YUYang , LIBo , GAOMing-xin , ZHANGFan

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

GUCheng-xiong, Email: anzhengu@sina.com

Keywords：

Side-to-side anastomosis; Coronary artery bypass grafting; Off-pump; Anastomotic patency

DOI：

10.7507/1007-4848.20140069

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To describe a technique of side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in coronary artery bypass grafting (CABG) and evaluate its clinical outcomes. Methods Twelve patients received side-to-side anastomosis at distal end of sequential vein grafts during off-pump CABG in Beijing Anzhen Hospital between October 2012 and March 2013. There were 7 male and 5 female patients with their age of 68.0±3.6 years. To evaluate clinical outcomes of the technique,intraoperative graft blood flow,pulsatility index (PI) and postoperative echocardiography and electrocardiography were examined. Results All the 12 patients successfully received off-pump CABG. Mean graft flow and PI near the distal end anastomosis were 21.1±8.6 ml/min and 2.1±1.0,respectively. Four patients who initially received end-to-side anastomosis underwent revision into side-to-side anastomosis intraoperatively,whose graft flow increased from 2 ml/min,7 ml/min,3 ml/min and 5 ml/min to 10 ml/min,32 ml/min,13 ml/min and 23 ml/min respectively,and whose PI decreased from 18.2,7.1,12.6 and 13.4 to 2.2,0.9,1.8 and 2.8,respectively. Distal end of target arteries were all posterior descending artery. The number of bypass grafts was 4.0±0.7. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome,malignant arrhythmias or perioperative myocardial infarction in this study. Conclusion Side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in off-pump CABG can produce higher anastomotic patency. Long-term follow-up outcomes of this technique are needed before widely clinical application.

Citation： LIHai-tao, GUCheng-xiong, YUYang, LIBo, GAOMing-xin, ZHANGFan. Side-to-side Anastomosis of Distal End of Sequential Vein Grafts to Small Target Arteries in Coronary Artery Bypass Grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 241-243. doi: 10.7507/1007-4848.20140069 Copy

1.	Nakano J,Okabayashi H,Noma H,et al.Early angiographic evaluation after off-pump coronary artery bypass grafting.J Thorac Cardiovasc Surg,2013,146 (5):1119-1125.
2.	Nordgaard H,Vitale N,Haaverstad R.Transit-time blood flow measurements in sequential saphenous coronary artery bypass grafts.Ann Thorac Surg,2009,87 (5):1409-1415.
3.	D'Ancona G,Karamanoukian HL,Ricci M,et al.Graft revision after Transit time flow measurement in off-pump coronary artery bypass grafting.Eur J Cardiothorac Surg,2000,17 (3):287-293.
4.	Li JR,Liu YM,Zheng J,et al.The patency of sequential and individual vein coronary bypass grafts:a systematic review.Ann Thorac Surg,2011,92 (4):1292-1298.
5.	王明岩,高长青,王刚,等.非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较.中国胸心血管外科临床杂志,2011,18 (5):399-403.
6.	Gao CQ,Wang MY,Wang G,et al.Patency of sequential and individual saphenous vein grafts after off-pump coronary artery bypass grafting.J Card Surg,2010,25 (6):633-637.
7.	Kabinejadian F,Ghista DN.Compliant model of a coupled sequential coronary arterial bypass graft:Effects of vessel wall elasticity and non-Newtonian rheology on blood flow regime and hemodynamic parameters distribution.Med Eng Phys,2012,34 (7):860-872.
8.	Sankaranarayanan M,Chua LP,Ghista DN,et al.Computational model of blood flow in the aorto-coronary bypass graft.Biomed Eng Online,2005,4:14.
9.	Kabinejadian F,Chua LP,Ghista DN,et al.A novel coronary artery bypass graft design of sequential anastomoses.Ann Biomed Eng,2010,38 (10):3135-3150.
10.	rauenfelder T,Boutsianis E,Schertler T,et al.Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts.Biomed Eng Online,2007,6:35.
11.	Bonert M,Myers JG,Fremes S,et al.A numerical study of blood flow in coronary artery bypass graft side-to-side anastomoses.Ann Biomed Eng,2002,30 (5):599-611.
12.	Qiao AK,Liu YJ.Influence of graft-host diameter ratio on the hemodynamics of CABG.Biomed Mater Eng,2006,16 (3):189-201.
13.	Staalsen NH,Ulrich M,Winther J,et al.The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo.J Vasc Surg,1995,21 (3):460-471.
14.	Fei DY,Thomas JD,Rittgers SE.The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses:a numerical model study.J Biomech Eng,1994,116 (3):331-336.
15.	于洋,张帆,高铭鑫,等.术中冠状动脉序贯桥即时血流测量的方法探讨.中国胸心血管外科临床杂志,2013,20 (5):524-528.

1. Nakano J,Okabayashi H,Noma H,et al.Early angiographic evaluation after off-pump coronary artery bypass grafting.J Thorac Cardiovasc Surg,2013,146 (5):1119-1125.
2. Nordgaard H,Vitale N,Haaverstad R.Transit-time blood flow measurements in sequential saphenous coronary artery bypass grafts.Ann Thorac Surg,2009,87 (5):1409-1415.
3. D'Ancona G,Karamanoukian HL,Ricci M,et al.Graft revision after Transit time flow measurement in off-pump coronary artery bypass grafting.Eur J Cardiothorac Surg,2000,17 (3):287-293.
4. Li JR,Liu YM,Zheng J,et al.The patency of sequential and individual vein coronary bypass grafts:a systematic review.Ann Thorac Surg,2011,92 (4):1292-1298.
5. 王明岩,高长青,王刚,等.非体外循环冠状动脉旁路移植术后大隐静脉序贯桥与单支桥中期通畅率的比较.中国胸心血管外科临床杂志,2011,18 (5):399-403.
6. Gao CQ,Wang MY,Wang G,et al.Patency of sequential and individual saphenous vein grafts after off-pump coronary artery bypass grafting.J Card Surg,2010,25 (6):633-637.
7. Kabinejadian F,Ghista DN.Compliant model of a coupled sequential coronary arterial bypass graft:Effects of vessel wall elasticity and non-Newtonian rheology on blood flow regime and hemodynamic parameters distribution.Med Eng Phys,2012,34 (7):860-872.
8. Sankaranarayanan M,Chua LP,Ghista DN,et al.Computational model of blood flow in the aorto-coronary bypass graft.Biomed Eng Online,2005,4:14.
9. Kabinejadian F,Chua LP,Ghista DN,et al.A novel coronary artery bypass graft design of sequential anastomoses.Ann Biomed Eng,2010,38 (10):3135-3150.
10. rauenfelder T,Boutsianis E,Schertler T,et al.Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts.Biomed Eng Online,2007,6:35.
11. Bonert M,Myers JG,Fremes S,et al.A numerical study of blood flow in coronary artery bypass graft side-to-side anastomoses.Ann Biomed Eng,2002,30 (5):599-611.
12. Qiao AK,Liu YJ.Influence of graft-host diameter ratio on the hemodynamics of CABG.Biomed Mater Eng,2006,16 (3):189-201.
13. Staalsen NH,Ulrich M,Winther J,et al.The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo.J Vasc Surg,1995,21 (3):460-471.
14. Fei DY,Thomas JD,Rittgers SE.The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses:a numerical model study.J Biomech Eng,1994,116 (3):331-336.
15. 于洋,张帆,高铭鑫,等.术中冠状动脉序贯桥即时血流测量的方法探讨.中国胸心血管外科临床杂志,2013,20 (5):524-528.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Side-to-side Anastomosis of Distal End of Sequential Vein Grafts to Small Target Arteries in Coronary Artery Bypass Grafting

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