Proximal Anastomosis First Sequential Bypass Technique: Better Safety For Off Pump Complete Coronary Revascularization.
Zhaoyun Cheng, Sr., Sheng Wang, Zhenwei Ge, Jian Zhao, Junjie Sun, Junlong Hu, Jizhong Xuan.
Henan Provincial People's Hospital, Zhengzhou, China.
Background: Complete coronary revascularization has been difficult in off-pump coronary artery bypass(OPCAB) grafting surgery for patients with multi vessel coronary disease. We reviewed our experience with the innovative technique of proximal-anastomosis-first sequential anastomosis in OPCAB surgical practice. Methods: Between Jan 2013 to November 2017, a total of 2827 patients with multiple vessel coronary artery disease underwent primary isolated OPCAB procedure. They were divided into two groups, i.e. proximal-anastomosis-first sequential technique group(the POPCAB, n=1517) andthe conventional distal-anastomosis-first sequentialfashion(COPCAB, n=1310) group. Preoperative and postoperative variables of the two groups were compared. Results:There were no significant differences inage, sex, previous history of myocardial infarction or comorbidities including hypertension, diabetes mellitus and number of grafts between the two groups. Conversion from off-pump to on-pump, malignant arrhythmia, and unstable hemodynamics, occurred more in the COPCAB group than that in the POPCAB group. Hemodynamic stability was maintained better in the POPCAB group than that in the COPCAB with an easy-management of blood pressure and cardiac rhythms. The heart performance, demonstrated by the parameters including CO, CI, SVR, PVR, and SvO2 level, improves more significantly in the POPCAB group, along with the increase of number of the sequential anastomosis as the previously ischemic myocardium gets more blood supply once the anastomosis was constructed. Thelength of stay in ICU and hospital for the POPCAB group was shorter than that in the COPCAB group. The CK-MB and other myocardial biomarkers level in POPCAB group was lower compared with COPCAB group. Conclusion: The study proved that the proximal-anastomosis-first sequential bypass grafting technique provides an improved safety approach of myocardial revascularization, and may optimize the outcome in the aged patients with multi vessel coronary diseases.
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