Abstract 2120: Arterial Graft Fate: Angiographic Flow Grading and Strategy for Graft Arrangement of Arterial Grafts
Objective: We sought to delineate the effect of antegrade bypass flow in arterial composite and sequential grafts on the intermediate term patency and examined the strategy for graft arrangement maximizing antegrade flow.
Methods; Angiograms of 2606 bypass grafts in consecutive 693 patients who underwent totally arterial off-pump CABG without aortic manipulation and early postoperative angiography since December 2000 were studied. The angiographic flow was graded as A(antegrade), B(competitive), C(reversal), and O(occlusion). In the late period(March 2003~), we anticipated bypass flow, and high risk situations of competitive and reverse flow were eliminated by selecting the orientation of the sequential grafts for avoiding end-to-side anastomosis with moderately stenotic branch, and maximal use of bilateral ITAs. Current graft arrangement consists of a pedicled ITA to anterior descending artery and a straight composite graft of right ITA and radial artery to circumflex and right coronary territories. The number of distal anastomoses was 3.8±1.0.
Results; Overall graft patency rate was 98.3% (2562/2606) in the early angiography. The rate of grade A was 91.3%(2379/2606), while the rates of grade B and C were 2.9%(74/2606) and 4.1%(107/ 2606), respectively. Multivariate logistic regression analysis demonstrated that the distal end of the graft (OR=7.73 p<0.0001), anastomotic sites per a pedicled ITA (OR=1.5, p<0.0001) and native coronary stenosis(%) (OR=0.91, p<0.0001) significant correlated with grade non-A. In the late angiography, the actuarial patency rate of the bypass grafts which were grade A in early angiography was 74.2%% at 3 years, and was significantly higher than that of the bypass grafts grade B or C (27.1%) (p<0.0001). The multivariate Cox Hazard model demonstrated that the absence of grade non-A, (OR=1.93, p=0.01), and Early Period (~ February 2003) (OR=4.07, p=0.001) were the significant predictors of the adverse cardiac events.
Conclusion; Antegrade bypass flow significantly correlated with the intermediate term patency of the arterial grafts. Appropriate strategy for graft arrangement was effective for minimizing competitive and reverse flow and improvement of intermediate-term outcomes of total arterial CABG.