Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery.

BACKGROUND: The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency. METHODS: Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, n = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, n = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG. RESULTS: There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842-60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453-9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081-0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139-0.812, p = 0.015) were significant protective factors. CONCLUSIONS: Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.

Distal anastomosis support for bypass grafting for the small posterior descending artery / 中华胸心血管外科杂志

Objective:To describe a distal anastomosis support (DAS) technique, and retrospectively investigate the effect of DAS on the mid-term graft patency of patient with small posterior descending artery.Methods:Between January and December 2016, 100 patients with triple-vessel disease and small PDA who continuously underwent off-pump coronary artery bypass grafting (OPCABG) (OPCABG group, n=50) and OPCABG with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCABG+ DAS group, n=50) were evaluated retrospectively. The dynamic changes of electrocardiogram and TnI level were observed within 48h after the surgery. All patients came back to follow-up visit 6th, 12th, 24th and 36th postoperative month. The primary endpoint was the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA.Results:There was no death during the operation. There was no acute inferior wall myocardial infarction confirmed by electrocardiogram. Peak TnI within 48h of surgery was 0.74(0.98)ng/ml vs. 0.92(1.29)ng/ml, P>0.05, and the number of patients with peak TnI≥70×ULN was 3(6%, 3/50) vs.5(10%, 5/50), P>0.05. There was no postoperative death, and all the patients were discharged 5-15 days postoperatively. We found significantly improved cumulative graft patency in OPCABG+ DAS group at 36 months after operation [85.7%(42/49) vs. 68.0%(34/50), P<0.05). In multivariate logistic regression analysis, PDA with atherosclerotic lesions ( OR=6.513, 95% CI: 1.279-33.180, P=0.024), and peak TnI≥70×ULN within 48 h of surgery ( OR=5.948, 95% CI: 1.128-31.368, P=0.036) were independent predictors of graft failure, whereas concomitant DAS ( OR=0.222, 95% CI: 0.069-0.713, P=0.011) was significant protective factor. Conclusion:Concomitant DAS conferred superior mid-term patency of SVG-PDA in patients with small PDA. Adding the DAS procedure to OPCABG may be a promising surgical option for small PDA with atherosclerotic lesions.

Distal Anastomosis Support for Coronary Artery Bypass Grafting: A New Surgical Technique and Current Outcomes.

BACKGROUND: Saphenous vein graft (SVG) failure remains the Achilles' heel of coronary artery bypass grafting (CABG) and grafts performed on the right coronary artery (RCA) system always have the worst patency compared with those performed on the left coronary system. The aim of this study was to introduce the distal anastomoses support (DAS) procedure and investigate the effect of DAS on the mid-term graft patency of SVG-PDA. METHODS: Between May and September 2013, 100 patients with an RCA severe lesion who underwent isolated OPCABG (CABG alone group, n=50) or CABG with DAS for anastomoses of SVG-PDA (CABG plus DAS group, n=50) were evaluated retrospectively. RESULTS: Patency rates of SVG-PDA at two years were significantly higher in the CABG plus DAS group compared to the CABG alone group (94.0% vs 74.0%, p = 0.006). However, there was no significant difference between the two groups with regard to freedom from MACCE at two years (92.0±3.8% versus 82.0±5.4%, p=0.08). No death occurred in both groups, and freedom from angina at two years did not differ significantly between two groups (80.0% vs 92.0%, p=0.62). In multivariate logistic regression analysis, diffuse disease was the independent predictor of graft occlusion (OR=11.05, 95% CI 2.14-57.12, p=0.004), but concomitant DAS (OR=0.04, 95% CI 0.003-0.350, p=0.004), proximal stenosis > 75% (OR=0.09, 95% CI 0.02-0.50, p=0.006), and male gender (OR=0.05, 95% CI 0.007-0.301, p=0.001) were protective factors. CONCLUSIONS: Concomitant DAS could improve mid-term patency of SVG-PDA. Adding the DAS procedure to CABG may be a new choice for patients with an RCA severe lesion.