Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow

Abstract

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.

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Long‑term graft patency after coronary artery bypass grafting: Effects of surgical technique

“…Over the decades, graft patency has been assessed for individual grafts alone and not for CABG as an entity per se , while the dilemma of designing an optimal grafting technique bringing considerable haemodynamic improvement and graft patency remained unsolved despite the increase in worldwide research. A literature review allowed us to classify factors influencing graft patency into morphological (vessel type, graft length, and calibre) (11,15), pathophysiological (competitive flow through the native coronary artery, graft degenerative changes) (15), and surgical (technical expertise, graft harvesting and preparation, grafting design, and anastomosis technique) categories (16,17). This single-centre study analysed graft patency according to surgical technique, namely proximal and distal anastomosis type and angle.…”