Abstract 2276: Competitive and Reversal Flow in Sequential and Composite Arterial Grafts in Off-Pump Coronary Revascularization: A 7-Year Experience of Angiographic Flow Grading
We sought to delineate the effect of competitive and reversal flow on the intermediate-term clinical and angiographic results. Clinical records and angiograms of 2930 bypass grafts in consecutive 763 patients who underwent total arterial off-pump CABG without aortic manipulation and early postoperative angiography since 2000 were studied. On angiography, dominant blood flow in the bypass graft was graded as A(antegrade), B(competitive), C(reversal), and O(no flow=occlusion). Late angiography was performed in 107 patients(14.0%) with 392 bypass grafts(13.4%) for clinical reasons. The number of distal anastomoses was 3.8±1.0 per patient. The follow-up period was 38±23 months. In the early angiography, the overall graft patency rate was 98.0% (2872/2930). The rate of grade A was 91.2%(2671/2930), while the rates of grade B and C were 3.0%(88/2930) and 3.9%(113/2930), respectively. The overall survival and cardiac-event (myocardial infarction, coronary intervention, and cardiac death) free rates were 95.6% and 84.8% at 6 years, respectively. The cumulative patency rates of grade A bypass grafts were 85.5% at 3 years and 77.4% at 5 years, while those of grade B/C bypass grafts were 41.0% at 3 years and 17.6% at 5 years, respectively (p<0.0001). Antegrade bypass flow significantly correlated with durable patency of arterial grafts. Appropriate theory for graft design aiming at prevention of competitive and reversal flow would be crucial for achieving the advantage of arterial materials.