BackgroundEnd-to-side anastomoses to connect the distal end of the great saphenous vein (GSV) to small target coronary arteries are commonly performed in sequential coronary artery bypass grafting (CABG). However, the oversize diameter ratio between the GSV and small target vessels at end-to-side anastomoses might induce adverse hemodynamic condition. The purpose of this study was to describe a distal end side-to-side anastomosis technique and retrospectively compare the effect of distal end side-to-side versus end-to-side anastomosis on graft flow characteristics.MethodsWe performed side-to-side anastomoses to connect the distal end of the GSV to small target vessels on 30 patients undergoing off-pump sequential CABG in our hospital between October 2012 and July 2013. Among the 30 patients, end-to-side anastomoses at the distal end of the GSV were initially performed on 14 patients; however, due to poor graft flow, those anastomoses were revised into side-to-side anastomoses. We retrospectively compared the intraoperative graft flow characteristics of the end-to-side versus side-to-side anastomoses in the 14 patients. The patient outcomes were also evaluated.ResultsWe found that the side-to-side anastomosis reconstruction improved intraoperative flow and reduced pulsatility index in all the 14 patients significantly. The 16 patients who had the distal end side-to-side anastomoses performed directly also exhibited satisfactory intraoperative graft flow. Three-month postoperative outcomes for all the patients were satisfactory.ConclusionsSide-to-side anastomosis at the distal end of sequential vein grafts might be a promising strategy to connect small target coronary arteries to the GSV.

Perivenous application of α-CA sealants exerts short-term beneficial effects on the vein graft and reduces inflammatory responses in a rabbit model of carotid artery bypass grafting. Long-term effects of α-CA on vein graft remodelling and the clinical significance of α-CA in CABG remain to be determined in future studies.

Objectives. The aim of this study was to test the effects of collagen external scaffold (CES) in intimal hyperplasia of vein grafts and explore its underlying mechanisms. Methods. Thirty-six New Zealand white rabbits were randomized into no-graft group, graft group, and CES group. The rabbit arteriovenous graft model was established. In CES group, the vein graft was wrapped around with CES. The hemodynamic parameters of vein grafts were measured intraoperatively and 4 weeks after operation by ultrasonic examination. Histological characteristics of vein grafts were also evaluated 4 weeks later. The mRNA and protein levels of proliferating cell nuclear antigen (PCNA), active cleaved-caspase-3 (ClvCasp-3), and smooth muscle 22 alpha (SM22α) were measured 4 weeks later by quantitative real-time PCR and western blot. Results. CES significantly improved the hemodynamic stability of vein grafts, with higher blood velocity and blood flow. Similarly, CES also markedly mitigated intimal hyperplasia and inhibited dilatation of vein grafts. In CES group, the upexpression of PCNA and ClvCasp-3 and the downexpression of SM22α were inhibited. Conclusion. CES exerts beneficial effects in mitigating intimal hyperplasia and improving remodeling of autogenous vein grafts, which may be associated with reducing the proliferation and apoptosis and preserving the phenotype of VSMCs.

Objective: The purpose of this study was to investigate the effect of different anastomotic positions on the early patency of the distal end-to-side anastomosis of sequential saphenous vein grafts (SVG) in off-pump coronary artery bypass grafting (OPCAB). Methods: A total of 259 patients who underwent OPCAB between August 2014 and August 2019 and presented for coronary computed tomography angiography (CCTA) to evaluate graft patency at 1 year post-OPCAB were analyzed. There are two kinds of distal end-to-side anastomosis of SVG, to posterior descending artery (PDA) and main trunk of right coronary artery (RCA). In all, 1044 distal coronary anastomoses on 518 grafts which included 180 left internal mammary artery (LIMA) grafts, individual 79 SVG and 259 sequential SVG were assessed using CCTA. The blood flow (BF), pulsatility index (PI), and patency of every anastomosis were recorded. Besides, comprehensive data of SV-PDA and SV-RCA patients was also compared. Results: The mean BF of SV-RCA was significantly higher than that of SV-PDA (31.71 ± 18.60 vs 22.62 ± 14.48, p = 0.001), and the PI value of SV-RCA was significantly lower than that of SV-PDA (2.57 ± 1.17 vs 3.50 ± 1.69, p = 0.001). The patency of RCA system was significantly lower than that of the LAD and the left circumflex system (79.25% vs 90.13%, 90.23% respectively, p = 0.001). In sequential SVG, the patency of SV-PDA was significantly lower than that of SV-RCA (74.01% vs 86.59%, p = 0.001). Although, there was no significant difference in left ventricular ejective fraction, the left ventricular end-diastolic diameter (LVDd) in SV-PDA group was significantly larger than that in SV-RCA (52.67 ± 8.72 mm vs 47.34 ± 7.55, p = 0.001). In addition, the target vessel diameter in SV-PDA group was smaller than that in SV-RCA group (1.52 ± 0.41 mm vs 3.17 ± 0.88 mm, p = 0.001). Conclusion: The early patency of sequential SVG end to RCA after OPCAB is generally superior to that of to PDA, especially for patients with large LVDd.

Background: This study sought to compare and evaluate the clinical efficacy and safety of Y-type coronary artery bypass grafting (CABG) and sequential CABG. However, the prognosis and complication rate of the two treatments are different. Therefore, we need to systematically compare the efficacy and safety of the two surgical schemes.Methods: A total of 112 patients who underwent Y-type CABG and 113 patients who underwent sequential CABG were selected from January 2020 to December 2020. The patients undergoing Y-type CABG of the great saphenous vein (SV) were classified as the experimental group, and those undergoing sequential anastomosis were classified as the control group. The intraoperative blood flow at each anastomotic site of the venous sequential CABG, left ventricular ejection fraction (LVEF), and left ventricular diastolic diameter (LVEDD) at the end of 3 months, 6 months, and 1 year after surgery, the incidence rate of major adverse cardiovascular events, and coronary angiography (CAG) after readmissions due to similar symptoms were compared between the 2 groups. The bridging vascular blockage rate was also determined.Results: There was no significant difference in cardiac function between the 2 groups in the short term, and the incidence of major adverse cardiovascular events in the 2 groups mainly occurred in the middlepostoperative period (1 year after surgery) or later. There was no statistical difference in the intraoperative real-time blood flow measurements at each anastomosis of the venous bridge between the 2 groups.Compared to the control group, the LVEF of the experimental group was significantly increased at the 1-year follow-up point (51.6±5.1 vs. 67.6±5.6, P=0.001). During the operation of Y-type coronary artery bypass grafting, the incidence of major adverse cardiovascular events, vascular bridge, and anastomotic blockage were significantly decreased (16 vs. 39, P=0.023).Conclusions: Large SV Y-type CABG can improve postoperative left heart function and reduce the incidence of postoperative adverse events, which may be of great significance for improving the postoperative mid-term survival rate of patients.

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Objective Effective therapies for the prevention of vein graft failure, which frequently occurs in coronary artery bypass grafting (CABG) due to intimal hyperplasia (IH), are still lacking. Here, we investigated the effects of the perivenous application of double-network hydrogel on vein grafts in carotid artery bypass grafting in a rabbit model. Methods Healthy New Zealand white rabbits were randomized into the following groups: no graft, graft, or graft + Double-network hydrogel external stent (DNHES). The rabbits’ carotid artery was bypassed via the jugular vein. Double-network hydrogel external stent was wrapped around the jugular graft after the anastomoses were completed. Blood flow parameters and tissue histology of the vein grafts were evaluated. Results Compared with the untreated vein grafts at 12 weeks after the surgery, the DNHES significantly improved graft flow, attenuated intimal and medial thickening, reduced the anti-proliferating cell nuclear antigen proliferation index of the vein grafts, decreased the mRNA and protein expression of Mitogen-Activated Protein Kinase (MAPK) and Transforming Growth Factor-β (TGF-β), and increased the mRNA and protein expression of endothelial Nitric Oxide Synthase (eNOS). Conclusion The perivenous application of DNHES exerts beneficial effects on vein grafts, reduces the inflammatory response in carotid artery bypass grafting in a rabbit model, and appears to be a safe and promising strategy to prevent vein graft failure.