Total Arterial Off-Pump Coronary Artery Bypass Grafting: A 10-Year Experience / 中华医学杂志(英文版)

<p><b>Background</b>Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting (CABG). We summarized our experience with total arterial off-pump coronary artery bypass grafting (OPCAB) and assessed the early clinical results, surgical complications, and follow-up.</p><p><b>Methods</b>From January 2007 to May 2017, 508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery (IMA)-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts.</p><p><b>Results</b>The average distal anastomosis was 2.34 ± 0.97 (range: 1-4). All the patients were discharged from hospital except one died. A total of 457 (90.32%) patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%, and 8.67%; rate of ischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population.</p><p><b>Conclusions</b>Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.</p>

Comparison of outcomes of two minimally invasive approaches for multi-vessel coronary revascularization / 北京大学学报(医学版)

Objective:To compare the safety and effectiveness of two minimally invasive approaches for multi-vessel coronary revascularization.Methods:From August 2014 to February 2017,70 consecutive patients who underwent minimally invasive coronary artery bypass grafting in Peking University Third Hospital were randomly divided into two groups.In one group,40 patients underwent staged-hybrid coronary revascularization (staged-HCR) treatment;in the other group,30 patients underwent minimally invasive total arterial revascularization with bilateral internal thoracic artery (BITA).In staged-HCR group,the patients underwent minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI) procedure for treatment of multi-vessel disease.In BITA group,the patients underwent total arterial coronary artery bypass grafting with composite "Y" BITA graft.Preoperative and postoperative data of the two groups,including postoperative blood usage,mechanical ventilation time,domiciling duration in intensive care unit (ICU),major adverse cerebral and cardiovascular event (MACCE),and postoperative coronary angiography results were compared,in order to evaluate the safety and effectiveness of these surgical approaches.Results:The preoperative characteristics of 70 patients in the two groups showed no significant difference.All the patients underwent successfully,elective minimally invasive multi-vessel coronary artery bypass grafting as scheduled preoperatively.Postoperative result showed the patients in staged-HCR group took advantages in less postoperative mechanical ventilation time [Staged-HCR group (11.2 ± 8.7) h vs.BITA group (18.3 ± 9.1) h,P =0.013],shorter domiciling duration in ICU [Staged-HCR group (26.29 ± 4.05) h vs.BITA group (44.74 ± 28.75) h,P =0.022],and less total drainage [Staged-HCR group (695.57 ± 250.46) mL vs.BITA group (1 103.26±547.44) mL,P =0.03] than the patients in the group of minimally invasive total arterial revascularization with BITA.Postoperative in hospital coronary angiography showed satisfactory graft patency rates in both groups [97.5％ in Staged-HCR group vs.97.8％ in BITA group].No MACCE occurred in both groups during hospitalization.Conclusion:Staged-HCR is a feasible method for the treatment of multi-vessel revascularization involving right coronary artery.Minimally coronary revascularization with BITA is associated with superior long-term graft patency and it's recommended for patients who could not tolerate dual-antiplatelet therapy.This study shows that both minimally invasive surgical approaches are safe and effective for treatment of patients with multi-vessel coronary artery disease.

Concomitant Aorto-axillary Bypass and Beating Heart Total Arterial Coronary Artery Bypass Grafting by RIMA-LIMA “Y” graft.

In common practice, left internal mammary artery (LIMA) along with great saphanous vein is used in coronary artery bypass grafting (CABG). Day by day total arterial CABG specially use of bilateral mammary arteries are becoming demanding. Coexisting occlusive disease may rarely affect coronary arteries along with left subclavian artery. We have reported a successful concomitant aorto-axillary bypass and CABG of a 52-year-aged man with the diagnosis of triple-vessel-disease (TVD) angiographically along with proximal stenosis in left subclavian artery. Aorto-axillary (left) bypass was done with 6-mm ring re-inforced polytetrafluoroethane (PTFE) graft and CABG was done by total arterial RIMA-LIMA “Y” graft on beating heart. The post-operative course was uneventful with reappearance of peripheral pulses in left upper extremity. The patient was discharged on the 9th post-operative day.

Total Arterial Revascularisation in Left Ventricular Dysfunction / 华中科技大学学报（医学）（英德文版）

The feasibility and safety of total arterial coronary revascularization with 2 arterial conduits in patients with impaired left ventricular function was evaluated. Data were prospectively collected on all patients with multiple vessel disease and moderately or severely impaired left ventricular function, who underwent coronary surgery with the intention of total arterial revascularization with 2 conduits between March 1995 and August 2002. One hundred and seventy-nine patients were included in the study. Acute coronary insufficiency was present in 3 patients and 43 had unstable angina. Severe left ventricular impairment was present in 29 patients. There were 17 redo operations including 3 redo-redo procedures. Eighty-two percent of patients had a Y graft configuration from the left internal mammary artery (right internal mammary artery 40. 8 %, radial artery 33.5 %,other 7.8 % ). The perioperative mortality was 2.2 %, myocardial infarction 1.7 % and stroke 0. 6 %.Total arterial revascularization in patients with ischaemic left ventricular dysfunction can be safely performed with 2 arterial conduits. The radial artery provides conduit length greater than the right internal mammary artery and allows full revascularization despite left ventricular dilatation.

Total Arterial Revascularization with Internal Mammary Artery or Radial Artery Graft Configuration / 华中科技大学学报（医学）（英德文版）

To investigate the clinical use of π graft in total arterial revascularization and its outcomes, a retrospective analysis of 23 patients out of 1000 patients undergoing total arterial coronary bypass surgery with a π graft between September 1994 and December 2004 was performed. In the selected patients for the management of triple vessel disease with middle diagonal/intermediate ramus disease such that a skip with the left internal mammary artery (LIMA) or radial artery (RA),the main stem of π graft, to the left anterior descending coronary artery (LAD) will not work and the right internal mammary artery (RIMA) or right gastroepiploic artery (RGEA) cannot pick up the diagonal/intermediate ramus, hence the LAD and diagonal/intermediate ramus were grafted with a mini Y graft using the distal segment of LIMA, RIMA, RA or RGEA, together with the bilateral internal mammary artery (BIMA) or LIMA-RA T graft to compose π graft. Twenty-three patients (18 males, 5 females) underwent the π graft procedure. There were no deaths or episodes of myocardial infarction, stroke, and deep sternal wound infection. One patient required reopening for controlling bleeding. Until the end of 2004, during a mean follow-up of 81.0 ±28.4 months, no angina needing re-intervention or operative therapy or coronary related death occurred. In conclusion, in patients with specific coronary artery anatomy/stenosis, the BIMA (sometimes LIMA with RA or RGEA) π graft can be successfully performed for total arterial revascularization with good midterm outcomes.