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Objectives:The aim of this study was to assess the influence of graft anastomosis strategies of radial artery on the flow characteristics and early patency in coronary artery bypass grafting(CABG). Methods:Present study enrolled 99 patients(92 males,7 females,aged[57.2±8.7]years),who underwent isolated CABG using a radial artery(RA)graft from January 2019 to December 2021 in our department.The RA was proximally anastomosed to the aorta in 79 patients(group 1)and to another graft as a composite graft in 20 patients(group 2).The intraoperative flow characteristics were evaluated with the transit time flow measurement(TTFM),and the graft patency was assessed by computed tomography coronary angiograms perioperatively and at 1year after operation respectively. Results:Baseline characteristics were similar between the two groups(all P＞0.05).There was no perioperative death.Incidence of minimally invasive cardiac surgery for CABG(MICS CABG)and mean flow(MF)of RA grafts were both higher in group 2 than in group 1(all P＜0.05).Perioperative RA graft failure rate was 24.2%(n=24),which tended to be lower in group 2 than in group 1(10.0%vs.27.8%,P=0.096).CT angiography showed that RA graft failure reduced to 16.1%at one year after operation.Compared to patency group,patients with failure RA grafts perioperatively had higher pulse index(PI)and lower intraoperative MF(all P＜0.05).Patients with failure RA grafts at one year after operation had higher PI and more bypassed to the right coronary artery(RCA)target territories of RA grafts(all P＜0.05). Conclusions:RA proximal anastomosis to the aorta or to another graft dose not affect the perioperative patency in CABG.Some RA graft that failed perioperatively might recanalize at one year after operation.High intraoperative PI and bypassed to RCA of RA grafts may be predictors of graft failure at one year after operation.
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ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.
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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery. METHODS: Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study. RESULTS: Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05). CONCLUSION: The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.
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@#Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. Methods A retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). Results A total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). Conclusion Cardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.
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@#Objective To evaluate the incidence of postoperative atrial fibrillation (POAF) after dexmedetomidine and diazepam in patients undergoing coronary artery bypass grafting (CABG). Methods A retrospective cohort study was conducted in the patients who underwent CABG in the General Hospital of Northern Theater Command from October 2020 to June 2021. By propensity score-matching method, the incidence of POAF after dexmedetomidine and diazepam application in patients undergoing CABG was evaluated. Results Finally 207 patients were collected, including 150 males and 57 females, with an average age of 62.02±8.38 years. Among the 207 patients, 53 were treated with dexmedetomidine and 154 with diazepam before operation. There was a statistical difference in the proportion of hypertension patients and smoking patients between the two groups before matching (P<0.05). According to the 1∶1 propensity score-matching method, there were 53 patients in each of the two groups, with no statistical difference between the two groups after matching. After matching, the incidence of POAF in the dexmedetomidine group was lower than that in the diazepam group [9.43% (5/53) vs. 30.19% (16/53), P=0.007]. There was no death in the two groups during hospitalization, and there was no statistical difference in the main adverse events after operation. The ICU stay (21.28±2.69 h vs. 22.80±2.56 h, P=0.004) and mechanical ventilation time (18.53±2.25 h vs. 19.85±2.01 h, P=0.002) in the dexmedetomidine group were shorter. Regression analysis showed that age, smoking and diabetes were related to the increased incidence of POAF (P<0.05), and preoperative use of dexmedetomidine was associated with a reduced incidence of POAF (P=0.002). Conclusion For patients undergoing CABG, the incidence of POAF with dexmedetomidine before operation is lower than that with diazepam. Preoperative application of dexmedetomidine is the protective factor for POAF, and old age, smoking and diabetes are the risk factors for POAF.
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@#We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.
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@#Since the advent of coronary artery bypass grafting (CABG), the selection of bypass conduits has always been one of the most controversial topics in this field. Arterial conduits have received extensive attention due to their excellent biological features and high patency. In recent years, the application of arterial grafting and total arterial grafting in China keeps increasing in recent years, but there is still a gap compared to the Europe and America. Previous clinical studies have indicated the benefits of the total arterial grafting in terms of patency and long-term outcomes, but the advantage of multiple arterial grafting over other procedures is still in need to be confirmed with high-quality randomized controlled trials. This article reviews the clinical application and strategy of total-arterial CABG, aiming to provide objective reference for future clinical research and application.
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ObjectiveTo investigate the application of endoscopy in obtaining the great saphenous vein （GSV） during coronary artery bypass grafting （CABG） and explore the learning curve， with a particular focus on common challenges encountered during the learning process and their impact on early clinical outcomes. MethodsA retrospective analysis was conducted on clinical data from 83 patients who underwent off-pump CABG with endoscopic GSV harvesting at the First Affiliated Hospital of Zhengzhou University from July 2013 to April 2014. Patients were categorized into four groups based on the chronological order of their hospitalization： Group A （novice group， n=20）， Group B （proficient group， n=20）， Group C （progressive group， n=20）， and Group D （mature group， n=23）. Differences in perioperative and midterm follow-up outcomes among the groups were analyzed to determine the learning curve period. ResultsThe study population had a mean age of （60.22±8.06） years and a mean body weight of （69.77±11.66） kg. Comorbidities included hypertension （24 cases）， diabetes （26 cases）， and subacute cerebral infarction （14 cases）. The novice group exhibited significantly shorter GSV length-to-harvest time ratio relative to the other three groups （P<0.001） and a significantly higher incidence of main vein damage （P=0.006）. However， there was no statistically significant difference in graft patency at the 1-year follow-up. ConclusionThorough and reliable technical training in endoscopic GSV harvesting is essential to minimize vascular injury caused by novice operators. Approximately 20 cases of hands-on experience and a careful self-analysis of procedural challenges are likely required to achieve proficiency in GSV harvesting.
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A 73-year-old woman presented at our hospital with dyspnea. Echocardiography showed severe aortic stenosis and a coronary angiography revealed right coronary artery disease. Therefore, we performed aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. Proximal anastomosis was initially attempted to the ascending aorta. However, the ascending aorta was thin and weak, we decided to anastomose to the side of the aortic arch. Proximal anastomosis was performed with an anastomotic device. Postoperative coronary computed tomography (CT) showed that the graft was patent.
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SUMMARY OBJECTIVE: The objective of this study was to reveal whether there was a possible relationship between the blood group and postoperative atrial fibrillation after off-pump coronary artery bypass grafting. METHODS: Between January 2020 and January 2022, 452 patients undergoing off-pump coronary artery bypass grafting surgery consisted of the research population. Patients were divided into two groups based on the occurrence of new-onset atrial fibrillation from the time of operation until discharge. Group 1 (atrial fibrillation group) had 122 patients, whereas group 2 (non-atrial fibrillation group) contained 350 patients. Patients' baseline clinical characteristics and operative and postoperative data were recorded and then compared between the groups. Moreover, a multivariate logistic regression analysis was also conducted to identify the predictors of postoperative atrial fibrillation. RESULTS: Non-O blood groups were substantially more common in the atrial fibrillation group than in the non-atrial fibrillation group. Patient age differences between the atrial fibrillation and non-atrial fibrillation groups were statistically significant, and patients in the atrial fibrillation group were detected to be older. Mean left atrial diameter, rates of obesity and prior percutaneous coronary intervention history, and perioperative intraaortic balloon pump requirement were significantly greater in the atrial fibrillation group than in the non-atrial fibrillation group. According to logistic regression analysis, blood group, age, left atrial diameter, obesity, and prior percutaneous coronary intervention were identified as predictors of postoperative atrial fibrillation. CONCLUSION: We demonstrated for the first time in the literature that ABO blood type was a novel and significant predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.
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Background: Revascularization of the coronary arteries is associated with better short term and long term prognosis in patients having multivessel coronary artery disease (MV-CAD) and chronic kidney disease (CKD). However, whether revascularization using coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI) using drug eluting stents (DES) is better remains unknown. Objectives: To compare the outcomes of revascularization by multi-vessel PCI using DES versus revascularization by CABG in patients with CKD having multivessel CAD, regarding in-hospital and one-year major adverse cardiovascular and cerebrovascular events (MACCE). Methods: This was a retrospective analysis of the data of a group of patients having CKD with eGFR less than 60 ml/min with multivessel CAD who underwent revascularization by PCI or revascularization by CABG and were compared as regards in-hospital and one-year MAACE. Results: A total of 565 patients were reviewed in this study, 230 patients had multivessel PCI using DES while 335 patients had CABG. Comparing both revascularization groups regarding in-hospital MACCE, patients who had mutli-vessel PCI had significantly lower in-hospital mortality, cerebrovascular events (stroke/TIA) and lower total MACCE than patients who had CABG (P-value = 0.03 & 0.01 & 0.04 respectively). When comparing both revascularization groups regarding one-year MACCE, patients who had mutli-vessel PCI had significantly lower cerebrovascular events and total MACCE than those patients who had CABG (P-value = 0.02 & 0.03 respectively). Conclusion: This is a retrospective study to determine which strategy is better for revascularization of CKD patients having multivessel CAD; we can conclude that multi-vessel PCI using DES for CKD patients and multivessel CAD had advantages over CABG regarding in-hospital and one-year cerebrovascular accidents (TIA/stroke) and regarding total MACCE. Larger randomized controlled trials are required to confirm our findings.
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Coronary Artery Bypass Grafting (CABG) Surgery is considered the standard treatment for revascularization in Coronary Artery Disease. The Off-Pump Coronary Artery Bypass Graft (OPCAB) which evades the use of Cardiopulmonary Bypass (CPB) became a popular CABG procedure, due to the adverse effect of CPB. Hypothetically, OPCAB may improve the rates of perioperative Myocardial Injury, Neurocognitive Impairment, Stroke and Mortality. However, some studies showed no superior outcomes for OPCAB compared to on-pump CABG. This study aims to evaluate the short-term and long-term outcomes of OPCAB versus On-Pump CABG. The results showed that OPCAB is probably a safe procedure for patients, especially for those with high-risk conditions. OPCAB procedure showed superior short-term outcomes in terms of Myocardial Infarction, Systemic Inflammatory Response, Postoperative Cognitive Dysfunction, Renal Failure, Stroke, Pulmonary Complication, Postoperative Transfusion, Hospital stay length and infection than On-pump CABG. However, regarding long-term outcomes, Off-Pump CABG had a higher rate of incomplete revascularization and repeat revascularization and a higher risk of long-term mortality as well as lower graft patency. Furthermore, the result showed that the higher experience of the surgeons in OPCAB improves the outcome of the Surgery.
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@#Objective To investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism. Methods Twelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation. Results Vascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001). Conclusion Intravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.
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@#Objective To explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation. Methods This retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG. Results In multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG. Conclusion The myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.
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A 70-year-old woman diagnosed with angina pectoris was scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) using the left internal thoracic artery and the saphenous vein (SVG). We performed a proximal anastomosis of the SVG to the ascending aorta using a clampless proximal anastomotic device. When this device was removed from the ascending aorta after completion of the SVG proximal anastomosis, we noticed the extensive appearance of an ascending aortic adventitial hematoma. Transesophageal echocardiography revealed a flap in the ascending aorta, which was diagnosed as an iatrogenic aortic dissection. The decision was made to immediately perform an additional aortic replacement. There was an intimal tear consistent with the device insertion site, which was identified as the site for the development of aortic dissection. After performing an ascending aortic replacement, coronary artery bypass grafting was performed. Her postoperative course was uneventful, and enhanced CT on postoperative day 12 showed aortic dissection up to the level of the abdominal aorta, but the false lumen was completely thrombosed. Iatrogenic aortic dissection caused by proximal anastomotic device during OPCAB is a very rare but serious complication, and early intraoperative diagnosis and prompt additional surgical treatment were considered necessary to save the patient's life.
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Man in his 70s, who had suffered from idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital with chest pain at rest. Coronary angiography revealed obstruction of the right coronary artery and triple vessel disease. Because a bleeding tendency was expected during coronary artery bypass grafting, we performed percutaneous coronary intervention to the culprit lesion first, and then intravenous immunoglobulin and high dose dexamethasone were tried. His platelet count rose from 49,000 to 103,000/mm3, so we performed coronary artery bypass grafting. The patient had no postoperative hemorrhagic complications. We believe that high dose dexamethasone therapy is useful for patients with ITP who need surgery immediately.
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@#Objective To study the relationship between preoperative heart rate variability (HRV) and postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Methods A retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command from May to September 2020 and received OPCAB. There were 217 males and 73 females aged 36-80 years. According to the incidence of POAF, the patients were divided into two groups: a non-atrial fibrillation group (208 patients) and an atrial fibrillation group (82 patients). The time domain and frequency domain factors of mean HRV 7 days before operation were calculated: standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences, percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms, low frequency power (LF), high frequency power (HF), LF/HF. Results The HRV value of patients without POAF was significantly lower than that of patients with POAF (P<0.05). The median SDNN of the two groups were 78.90 ms and 91.55 ms, respectively. Age (OR=3.630, 95%CI 2.015-6.542, P<0.001), left atrial diameter (OR=1.074, 95%CI 1.000-1.155, P=0.046), and SDNN (OR=1.017, 95%CI 1.002-1.032, P=0.024) were independently associated with the risk of POPAF after OPCAB. Conclusion SDNN may be an independent predictor of POAF after OPCAB.
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Objective To explore left ventricular longitudinal systolic function changes during perioperative period of coronary artery bypass graft(CABG).Methods Totally 41 patients with confirmed coronary artery disease(CAD)who underwent CABG were prospectively enrolled.The preoperative left ventricular global longitudinal strain(GLS),as well as GLS on the day of CABG,on the 3rd and 7th day postoperation were measured.According to preoperative left ventricular GLS,the patients were divided into 3 groups,i.e.normal group(group A,GLS≤-18.1％,n=6),mildly decreased group(group B,-18.1％＜GLS≤-14.0％,n=22)and severely decreased group(group C,GLS＞-14.0％,n=13).Repeated measures analysis of variance,generalized estimating equation and multiple comparisons were used to analyze left ventricular systolic function in different perioperative time points.Results No significant difference of GLS was found among different time points during perioperative period of CABG in group A and C(all adjusted P＞0.05).In group B,GLS on postoperative days were lower than that before CABG(all adjusted P＜0.001),and the lowest value was observed on the day of CABG postoperatively,while no significant difference of GLS was found between the 3rd and 7th day postoperation(adjusted P=1.00).Compared with those before CABG,the longitudinal strain(LS)of basal segment on the day of CABG postoperatively and 3rd day postoperation,of middle segment and apical segment at all postoperative time points were lower(all adjusted P＜0.05),while of the apical segment on the day of CABG postoperatively decreased most obviously.No significant difference of LS of each ventricular segment was found between the 3rd nor the 7th day postoperation(all adjusted P＞0.05).Conclusion GLS decreased significantly on the day of CABG postoperatively but partially recovered within the following week in CAD patients with mildly decreased preoperative GLS.CABG had the most pronounced effect on LS of apical segment in left ventricle.
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Objective:To evaluate the safety of total artery coronary artery bypass grafting(CABG) in patients with coronary heart disease and the short- and mid-term clinical outcomes.Methods:A retrospective analysis of the clinical data of 100 patients who underwent CABG treatment in the First Affiliated Hospital of Guangxi Medical University from January 2016 to July 2021. Of these, 50 patients were selected for comparison(TACR) with the left internal thoracic artery and radial artery(RA) as grafts. However, the left internal thoracic artery and the great saphenous vein were used as grafts in other 50 patients were selected as controls(NCR). The clinical data of preoperative, perioperative, and postoperative(3 months, 6 months, 1 year and 5 years) for two groups were compared.Results:In the perioperative period, TACR group was inferior to the control in both operation time and 24 h postoperative drainage. But the peak value of hypersensitive troponin T was lower than that of NCR. There was no significant difference between the two groups in terms of mechanical ventilation time and perioperative mortality. There was no significant difference between the two groups in terms of left ventricular ejection fraction(LVEF), recurrent angina, left ventricular end-diastolic diameter and recurrent myocardial infarction at 3 and 6 months after operation. LVEF in TACR was better than that in NCR at 1 year and 5 years postoperatively.Conclusion:The clinical effect of CABG with RA as bridge vessel carried out in our center is obvious. TACR is safe and feasible due to its good mid-term efficacy and is not likely to cause postoperative complications.