Abstract 743: Efficacy Of Sequential And Composite Arterial Grafts In Off-pump Complete Revascularization For More Than Five Coronary Branches
Background: Indication for coronary artery bypass grafting (CABG) has been extending to patients at high risk and coronary systems severely diseased. We sought to examine efficacy of total arterial CABG to more than five coronary branches including small vessels.
Methods; Angiograms of 1460 bypass grafts in 325 patients with 3-vessel disease who underwent off-pump CABG without aortic manipulation and early postoperative angiography since 2000 were reviewed. Complete revascularization using bilateral in-situ internal thoracic and radial arteries was carried out in all patients. Of these, 177(54.5%) patients in group A had 3 or 4 distal anastomoses whereas 148(45.5%) patients in group B had more than 5 distal anastomoses for multiple stenotic lesions. In group A, 171/666(25.7%) target vessels were small (1.25mm or less in diameter, measured at operation), while 276/794(34.8%) were small in group B. Bypass flow was measured at the proximal site of the in-situ internal thoracic artery by a transit-time flow meter during operation. Graft materials used, baseline characteristics and LV function were similar in the two group, except for advanced age in group B (62±9 vs. 65±7, p=0.004). Distal anastomoses were 4.5±0.9 per patient. The follow-up period was 32±21 months.
Results; There was no early death. The amount of bypass flow was comparable in these groups (76±35ml/min vs. 81±36; p=0.12). Early angiography demonstrated that the graft patency rates were 97.3%(648/666) in group A and 98.4%(781/794) in group B, respectively (p=0.16). The graft patency rates for small vessels were 96.5%(165/171) in group A and 98.2%(271/276) in group B (p=0.26). The cumulative survival and cardiac event (myocardial infarction, repeated coronary intervention, and cardiac death) free rates at 5 years in group B were 97.6% and 85.6%, being comparable with those of 97.8% and 86.0% in group A (p=0.85, p=0.88), respectively.
Conclusions; Total arterial off-pump CABG with more than 5 distal anastomoses could be safely performed with satisfactory angiographic patency, even for small coronary vessels, using no additional graft material. It might contribute to achieve sufficient graft flow and favorable clinical outcomes in patients with multiple stenotic lesions.