Antegrade sequential anastomosis of great saphenous veins in off-pump coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WANG Peishan , FANG Lei , JIN Qilin , SHI Chuang , QI Delin , WANG Po

Department of Cardiac Surgery, Capital Medical University Daxing Teaching Hospital, Beijing, 102600, P.R.China;

Corresponding author：

WANG Peishan, Email: Wang_P_Shan@hotmail.com

Keywords：

Great saphenous vein; sequential anastomosis; coronary artery bypass grafting

DOI：

10.7507/1007-4848.201508016

Video：

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Objective To summarize the treatment outcomes of antegrade sequential anastomosis of great saphenous veins in off-pump coronary artery bypass grafting for coronary atherosclerotic heart disease. Methods A total of 116 patients with coronary atherosclerotic heart diseases underwent off-pump coronary artery bypass grafting from January 2013 to June 2015 in our hospital. There were 63 males and 53 females with a mean age of 42–80 (64.26±9.67) years. Left internal mammary artery was anastomosed to left anterior descending artery. The rest of the target vessels received antegrade sequential anastomosis of great saphenous veins with the order of proximal ascending aorta, diagonal branch, circumflex branch, obtuse marginal branch, left ventricular branch and posterior descending artery. Results All patients were performed off-pump coronary artery bypass grafting successfully without death or perioperative myocardial infarction. A total of 436 grafts were adopted with 3.75±0.53 in each patient. Three patients suffered low cardiac output syndrome, and were cured after administration of vasoactive drugs combined with the intra-aortic balloon pump. One patient suffered tardive pericardial tamponade and one acute renal failure, who were cured with disappearance of angina symptoms and increase of activities without discomfort. Conclusion Antegrade sequential anastomosis, as a safe and effective method, can reduce aortic stoma, save the length of grafts, shorten operative time and quickly restorate blood supply of myocardium in off-pump coronary artery bypass grafting.

Citation： WANG Peishan, FANG Lei, JIN Qilin, SHI Chuang, QI Delin, WANG Po. Antegrade sequential anastomosis of great saphenous veins in off-pump coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(5): 359-362. doi: 10.7507/1007-4848.201508016 Copy

1.	Haltky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for muhivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet, 2009, 373(9670): 1190-1197.
2.	Lamy A, Tong W, Devereaux PJ, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg, 2014, 98(5): 1620-1625.
3.	Nakajima H, Kobayashi J, Tagusari O, et al. Functional angiographic evaluation of individual, sequential, and composite arterial grafts. Ann Thorac Surg, 2006, 81(3): 804-814.
4.	Wu CT, Camacho FT, Zhao SY, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg, 2013, 95(4): 1297-1305.
5.	Chaudhry UA, Harling L, Rao C, et al. Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes. Ann Thorac Surg, 2014, 98(2): 563-572.
6.	Dalén M, Ivert T, Holzmann MJ, et al. Long-term survival after off-pump coronary artery bypass surgery: A Swedish nationwide cohort study. Ann Thorac Surg, 2013, 96 (6): 2054-2060.
7.	Lisboa LA, Mejia OA, Dallan LA. Which patients will benefit more from off-pump coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2014, 147(1): 540-541.
8.	Elmistekawy EM, Gawad N, Bourke M, et al. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg, 2012, 27(1): 1-5.
9.	Dreifaldt M, Mannion JD, Bodin L, et al. The no-touch saphenous vein as the preferred second conduit for coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1): 105-111.
10.	Song SW, Sul SY, Lee HJ, et al. Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients: A randomized controlled trial. Korean Circ J, 2012, 42(2): 107-112.
11.	Flemma RJ, Johnson WD, Lepley D Jr. Triple aorto-coronary vein bypass as treatment for coronary insufficiency. Arch Surg, 1971, 103(1): 82-83.
12.	Kieser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovase Surg, 1986, 91(5): 767-772.
13.	Christenson JT, Schmuziger M. Sequential venous bypass grafts: results 10 years later. Ann Thorae Surg, 1997, 63(2): 371-376.
14.	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.
15.	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.
16.	Hartz AJ, Manley JC, Walker JA, et al. Trends during 25 years of coronary artery bypass operation at St. Luke’s medical center in Milwaukee Wisconsin. Ann Thorac Surg, 2000, 69(3): 829-833.
17.	AI-Ruzzeh S, George S, Bustami M. The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique. J Thorac Cardiovasc Surg, 2002, 123(3): 525-530.
18.	Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg, 2012, 94(5): 1761-1781.
19.	Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel inaddition to aspirin in patients with acute coronary syndromes without segment elevation. N Engl J Med, 2001, 345(7): 494-502.
20.	Ebrahimi R, Bakaeen FG, Uberoi A, et al. Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg, 2014, 97(1): 15-21.

1. Haltky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for muhivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet, 2009, 373(9670): 1190-1197.
2. Lamy A, Tong W, Devereaux PJ, et al. The cost implications of off-pump versus on-pump coronary artery bypass graft surgery at one year. Ann Thorac Surg, 2014, 98(5): 1620-1625.
3. Nakajima H, Kobayashi J, Tagusari O, et al. Functional angiographic evaluation of individual, sequential, and composite arterial grafts. Ann Thorac Surg, 2006, 81(3): 804-814.
4. Wu CT, Camacho FT, Zhao SY, et al. Long-term mortality of coronary artery bypass graft surgery and stenting with drug-eluting stents. Ann Thorac Surg, 2013, 95(4): 1297-1305.
5. Chaudhry UA, Harling L, Rao C, et al. Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes. Ann Thorac Surg, 2014, 98(2): 563-572.
6. Dalén M, Ivert T, Holzmann MJ, et al. Long-term survival after off-pump coronary artery bypass surgery: A Swedish nationwide cohort study. Ann Thorac Surg, 2013, 96 (6): 2054-2060.
7. Lisboa LA, Mejia OA, Dallan LA. Which patients will benefit more from off-pump coronary artery bypass grafting? J Thorac Cardiovasc Surg, 2014, 147(1): 540-541.
8. Elmistekawy EM, Gawad N, Bourke M, et al. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg, 2012, 27(1): 1-5.
9. Dreifaldt M, Mannion JD, Bodin L, et al. The no-touch saphenous vein as the preferred second conduit for coronary artery bypass grafting. Ann Thorac Surg, 2013, 96(1): 105-111.
10. Song SW, Sul SY, Lee HJ, et al. Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients: A randomized controlled trial. Korean Circ J, 2012, 42(2): 107-112.
11. Flemma RJ, Johnson WD, Lepley D Jr. Triple aorto-coronary vein bypass as treatment for coronary insufficiency. Arch Surg, 1971, 103(1): 82-83.
12. Kieser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovase Surg, 1986, 91(5): 767-772.
13. Christenson JT, Schmuziger M. Sequential venous bypass grafts: results 10 years later. Ann Thorae Surg, 1997, 63(2): 371-376.
14. 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.
15. 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.
16. Hartz AJ, Manley JC, Walker JA, et al. Trends during 25 years of coronary artery bypass operation at St. Luke’s medical center in Milwaukee Wisconsin. Ann Thorac Surg, 2000, 69(3): 829-833.
17. AI-Ruzzeh S, George S, Bustami M. The early clinical and angiographic outcome of sequential coronary artery bypass grafting with the off-pump technique. J Thorac Cardiovasc Surg, 2002, 123(3): 525-530.
18. Ferraris VA, Saha SP, Oestreich JH, et al. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations. Ann Thorac Surg, 2012, 94(5): 1761-1781.
19. Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel inaddition to aspirin in patients with acute coronary syndromes without segment elevation. N Engl J Med, 2001, 345(7): 494-502.
20. Ebrahimi R, Bakaeen FG, Uberoi A, et al. Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg, 2014, 97(1): 15-21.

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Antegrade sequential anastomosis of great saphenous veins in off-pump coronary artery bypass grafting

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