The efficacies of sequential versus simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 FANG Lei , WANG Pishan , JIN Qilin , SHI Chuang , WANG Po

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

Corresponding author：

FANG Lei, Email: Fanglei868@163.com

Keywords：

Coronary heart disease; sequential anastomosis; simple anastomosis; coronary artery bypass grafting; propensity score matching study

DOI：

10.7507/1007-4848.202008044

Video：

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Objective To evaluate the short- and mid-term outcomes of sequential anastomosis and simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting.Methods The clinical data of 438 patients who underwent sequential anastomosis of saphenous vein and 165 patients who underwent simple anastomosis of saphenous vein from 2015 to 2018 in Daxing Teaching Hospital were retrospectively analyzed. After propensity score matching, 130 pairs of patients were included in the sequential anastomosis group [78 males and 52 females, aged 60 (52, 68) years] and simple anastomosis group [80 males and 50 females, aged 61 (52, 70) years]. The short- and mid-term clinical outcomes were compared.Results The two propensity score-matched groups had similar baseline clinical data. No significant difference was found between sequential anastomosis and simple anastomosis groups in the in-hospital outcomes, including in-hospital death (1.5% vs. 1.5%, P=1.000), the incidence of complications (4.6% vs. 6.2%, P>0.05), and the mean flow of grafts (30.0±11.8 mL/min vs. 28.0±9.5 mL/min, P=0.597). The operation time of the sequential anastomosis group was shorter than that of the simple anastomosis group (142.5±21.2 min vs. 186.3±27.6 min, P<0.001). The drainage of the sequential anastomosis group was less than that of the simple anastomosis group (204.7±39.6 mL vs. 271.3±48.3 mL, P<0.001). The follow-up time was 12-60 (28.3±8.9) months, during which the mortality of the two groups was not statistically different (3.2% vs. 4.0%, P=0.796).Conclusion The saphenous vein sequential anastomosis of saphenous vein is superior to the simple anastomosis. Sequential anastomosis technique can reduce aortic anastomosis, shorten operation time, and reduce bleeding drainage during off-pump coronary artery bypass grafting. The short- and mid- term clinical effects are satisfactory.

Citation： FANG Lei, WANG Pishan, JIN Qilin, SHI Chuang, WANG Po. The efficacies of sequential versus simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting: A propensity score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(2): 228-232. doi: 10.7507/1007-4848.202008044 Copy

1.	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.
2.	Hlatky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials. Lancet, 2009, 373(9670): 1190-1197.
3.	Benedetto U, Altman DG, Gerry S, et al. Off-pump versus on-pump coronary artery bypass grafting: Insights from the arterial revascularization trial. J Thorac Cardiovasc Surg, 2018, 155(4): 1545-1553.
4.	Arom KV, Flavin TF, Emery RW, et al. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(3): 704-710.
5.	Barandon L, Richebé P, Munos E, et al. Off-pump coronary artery bypass surgery in very high-risk patients: Adjustment and preliminary results. Interact Cardiovasc Thorac Surg, 2008, 7(5): 789-793.
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.	Ueki C, Miyata H, Motomura N, et al. Off-pump technique reduces surgical mortality after elective coronary artery bypass grafting in patients with preoperative renal failure. J Thorac Cardiovasc Surg, 2018, 156(3): 976-983.
8.	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.
9.	Carrel T, Winkler B. Current trends in selection of conduits for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2017, 65(10): 549-556.
10.	McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg, 2016, 102(1): 132-138.
11.	Kieser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovasc Surg, 1986, 91(5): 767-772.
12.	Christenson JT, Schmuziger M. Sequential venous bypass grafts: Results 10 years later. Ann Thorac Surg, 1997, 63(2): 371-376.
13.	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.
14.	Li J, Liu Y, 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.
15.	Tokuda Y, Song MH, Ueda Y, et al. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2007, 84(6): 1928-1933.
16.	Rossi M, Jiritano F, Malta E, et al. Competitive flow between a vein and an arterial graft at transit-time flow measurement. Interact Cardiovasc Thorac Surg, 2012, 15(2): 288-289.
17.	Puskas JD, Gaudino M, Taggart DP. Experience is crucial in off-pump coronary artery bypass grafting. Circulation, 2019, 139(16): 1872-1875.
18.	Hwang HY, Lee KH, Han JW, et al. Equivalency of saphenous vein and arterial composite grafts: 5-year angiography and midterm clinical follow-up. Ann Thorac Surg, 2016, 102(2): 580-588.
19.	Gaudino M, Fremes S, Schwann TA, et al. Technical aspects of the use of the radial artery in coronary artery bypass surgery. Ann Thorac Surg, 2019, 108(2): 613-622.

1. 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.
2. Hlatky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: A collaborative analysis of individual patient data from ten randomised trials. Lancet, 2009, 373(9670): 1190-1197.
3. Benedetto U, Altman DG, Gerry S, et al. Off-pump versus on-pump coronary artery bypass grafting: Insights from the arterial revascularization trial. J Thorac Cardiovasc Surg, 2018, 155(4): 1545-1553.
4. Arom KV, Flavin TF, Emery RW, et al. Safety and efficacy of off-pump coronary artery bypass grafting. Ann Thorac Surg, 2000, 69(3): 704-710.
5. Barandon L, Richebé P, Munos E, et al. Off-pump coronary artery bypass surgery in very high-risk patients: Adjustment and preliminary results. Interact Cardiovasc Thorac Surg, 2008, 7(5): 789-793.
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. Ueki C, Miyata H, Motomura N, et al. Off-pump technique reduces surgical mortality after elective coronary artery bypass grafting in patients with preoperative renal failure. J Thorac Cardiovasc Surg, 2018, 156(3): 976-983.
8. 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.
9. Carrel T, Winkler B. Current trends in selection of conduits for coronary artery bypass grafting. Gen Thorac Cardiovasc Surg, 2017, 65(10): 549-556.
10. McNeely C, Markwell S, Vassileva C. Trends in patient characteristics and outcomes of coronary artery bypass grafting in the 2000 to 2012 medicare population. Ann Thorac Surg, 2016, 102(1): 132-138.
11. Kieser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovasc Surg, 1986, 91(5): 767-772.
12. Christenson JT, Schmuziger M. Sequential venous bypass grafts: Results 10 years later. Ann Thorac Surg, 1997, 63(2): 371-376.
13. 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.
14. Li J, Liu Y, 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.
15. Tokuda Y, Song MH, Ueda Y, et al. Predicting early coronary artery bypass graft failure by intraoperative transit time flow measurement. Ann Thorac Surg, 2007, 84(6): 1928-1933.
16. Rossi M, Jiritano F, Malta E, et al. Competitive flow between a vein and an arterial graft at transit-time flow measurement. Interact Cardiovasc Thorac Surg, 2012, 15(2): 288-289.
17. Puskas JD, Gaudino M, Taggart DP. Experience is crucial in off-pump coronary artery bypass grafting. Circulation, 2019, 139(16): 1872-1875.
18. Hwang HY, Lee KH, Han JW, et al. Equivalency of saphenous vein and arterial composite grafts: 5-year angiography and midterm clinical follow-up. Ann Thorac Surg, 2016, 102(2): 580-588.
19. Gaudino M, Fremes S, Schwann TA, et al. Technical aspects of the use of the radial artery in coronary artery bypass surgery. Ann Thorac Surg, 2019, 108(2): 613-622.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The efficacies of sequential versus simple anastomosis of saphenous vein in off-pump coronary artery bypass grafting: A propensity score matching study

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