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OBJECTIVE:The purpose of this study was to investigate early and long-term outcome of arterial grafts including composite arterial grafts in off-pump coronary artery bypass grafting (OPCAB).
METHODS: 446 patients who underwent OPCAB between January 2002 and August 2011 were enrolled. Early and long-term graft patency was evaluated by coronary angiography in 91% and 19%, respectively. Freedom from major adverse cardiac event (MACE) and long-term survival were also analyzed using Kaplan-Meier method.
RESULTS: Mean coronary artery lesion was 2.7±0.5 branches (LMT lesion, 30%; LMT+3 vessel lesion, 12%), and the mean bypass grafting number was 2.9±1.1 branches. Bypass grafts used in this series were as the following; LITA 426 (96%), RITA 203 (46%), radial artery 190 (43%), GEA 78 (17%) and SVG 170(38%). Early and long-term patency of the graft were as the following; LITA-LAD (98.6%/ 98.2%), in-situ LITA sequential graft (95.6%/ 94.2%), RITA-LAD (98.2%/ 95.6%), A-C bypass using radial artery (96.1%/ 95.1%), T/ Y-composite graft (97.4%/ 91.4%) and I-composite graft (96.3%/88.1%), respectively. The main cause of graft deterioration of composite graft was flow competition. In I-composite graft, patency of the distal anastomotic site was the lowest. Furthermore, the rate of composite anastomotic stenosis was increased in long-term. Hospital mortality was 0.67% (3 cases). Long-term survival in 3, 5, 7 years were 96%, 93% and 93%, respectively. Freedom from MACE in 3, 5, 7 years were 85%, 80% and 76%, respectively.
CONCLUSIONS: The T/ Y-composite graft should be used in selected cases, because the pattern and degree of flow competition were unpredictable. In I-composite graft, the distal anastomotic site has to be placed to the coronary of severe stenosis to avoid flow competition.