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Objective:To report the use of right internal mammary artery (RIMA) in coronary artery bypass grafting (CABG) in our center, summarize the purpose and configuration of RIMA graft in CABG.Methods:All clinical data of coronary artery bypass grafting patients in our center performed in the past 6 years were collected and analyzed retrospectively. Those patients were divided into RIMA group and non-RIMA group according to the use of RIMA. Propensity score matching had been performed before these data was compared. Surgical technique of use of RIMA was summarized.Results:1 537 CABG had been performed from January 1st, 2016 to October 31st, 2021 in our center. Of which, 128 cases were allocated to RIMA group. After propensity score matching having been performed, there was no difference in baseline data between the RIMA group and the non-RIMA group (128 cases), and the RIMA group had more grafts and arterial grafts than the non-RIMA group. The postoperative drainage volume in the RIMA group was more than that of the non-RIMA group. However, there was no statistical significance in difference of transfusion between two groups. Also, there was no difference in postoperative mechanical ventilation time, ICU time and length of stay postoperatively. The postoperative complications were similar between two groups. Postoperative patency rate of the RIMA graft was as high as 95.2%. The target vessels of RIMA included left anterior descending branch (45 cases), diagonal branch (19 cases), intermediate branch (12 cases). obtuse marginal or circumflex branch (16 cases), posterior descending branch (5 cases) and right coronary trunk (18 cases). 41 RIMA used as free grafts, 87 used as in situ grafts, of which 19 RIMA need lengthened by other graft vessels.Conclusion:The patency rate of RIMA graft is high and the application of RIMA do not increase the surgical risk significantly. However, there are versatile contour of RIMA grafts. It can be used as artery graft in selected patients.
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Objective:To analyze the influence of application of bilateral internal mammary artery(BIMA) with different configurations in coronary artery bypass grafting(CABG).Methods:From January 2018 to December 2020, 82 patients underwent CABG using BIMA were included, with 75 males and 7 females, aged(56.9±9.8) years old. According to the target of coronary artery of BIMA, patients were divided into two groups, 23 patients(group B) who underwent the traditional operation(RIMA to the right coronary artery), and 59 patients(group L) whose RIMA were grafted to the left ventricular arteries. Also the patients were divided into two groups according to the RIMA used either in situ(group I, 57 cases) or free(group F, 25 cases). Compare the grafts flow between groups. The CTA angiography of coronary artery was completed to evaluate the grafts patency before discharge.Results:There was 1 early operative death(1.22%). The mean flow(MF) of RIMA was significantly higher in group B( P=0.013). The pulsatility index(PI) of LIMA was significantly lower and the MF of RIMA and BIMA was higher(all P<0.05), fewer patients with LIMA-MF less than 15 ml/min( P=0.023)in the group I. CTA angiography before discharge showed that only 1 RIMA to right coronary artery was occlusion. Conclusion:It is better to use BIMA in situ in CABG, RIMA used in right coronary artery can receive more satisfactory graft flow. BIMA has good patency in early stage, therefore is the ideal and stable coronary bypass graft.
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Objective: To compare the blood lfow of left internal mammary artery (LIMA) graft vessel between minimally invasive direct coronary artery bypass (MIDCAB) and traditional median sternotomyin off-pump coronary artery bypass (Traditional OPCAB) by transit-time lfow meter (TTFM). Methods: We retrospectively studied 300 patients who received OPCAB in our hospital from 2013-01 to 2015-07, all patients had LIMA to left anterior descending coronary artery (LAD) anastomosis. The patients were divided into 2 groups: MIDCAB group, n=70 and Traditional OPCAB group,n=230. Intra-operative blood lfow in graft vessel was measured by transit-time lfow meter. Pre- and post-operative indexes and the mean lfow (MF), pulsatile index (PI), diastolic fraction (DF) of LIMA graft were compared between 2 groups. Results: The following indexes in Traditional OPCAB group and MIDCAB group were as below: intra-operative transfusion was (3.00±5.42) U vs (1.06±2.17) U, post-operative peak value of cTnI was (2.84±9.93) ng/ml vs (0.69±1.74) ng/ml, mechanical ventilation time was (27.9±66.9) h vs (14.2±20.8) h and ICU stay time was (64.1±89.6) h vs (35.2±39.2) h, allP0.05. Conclusion: With LIMA to LAD graft, MIDCAB may achieve the same effect as traditional OPCAB, the early post-operative anastomosis has been reliable.