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Piggyback Anastomotic Technique For Coronary Artery Bypass Grafting. Single Surgeon Experience
Gianluca Torregrossa1, Massimo Baudo
2, Serge Sicouri
2, Basel Ramlawi
1, Courtney Murray
1, MaryAnn Wertan
1, Francis Sutter
1;
1Lankenau Medical Center, Wynnewood, PA, USA,
2Lankenau Institute of Medical Research, Wynnewood, PA, USA
BACKGROUND: To investigate mid-term clinical and angiographic outcomes following coronary artery bypass grafting (CABG) following the use of piggyback proximal aortic-coronary graft anastomosis technique.
METHODS: All consecutive 74 patients undergoing CABG with the piggyback proximal aortic-coronary graft anastomosis technique during 07/2021-02/2023, from a single surgeon, were included in the study. The piggyback technique consists in performing one single hole in the ascending aorta to be used for the proximal side anastomosis of two arterial or venous grafts which distal sides has been anastomosed to the right and obtuse marginal coronary arteries. In patients undergoing off-pump CABG, the encompass device was used to facilitate the proximal side anastomosis. We hypothesize that one single hole in the ascending aorta reduces the incidence of plaque mobilization and stroke. Therefore, patients with a high risk of stroke had a piggyback anastomotic technique used.
RESULTS: Mean age was 66.4 years and mean STS-PROM risk score was 1.3%. A total of 69 (93.2%) patients had off-pump CABG, 74 (100%) had left internal thoracic artery was with mean flow of 59 (±33.4) ml/min, 47 (63.5%) had a second arterial graft, and 19 (25.7%) had at least one graft used for sequential anastomoses on coronary arteries. There were no perioperative deaths or myocardial infarctions (MI). Postoperatively, mean ventilation time was 3.2 (±4.6) hours, mean hospital stay was 5.8 days, and there was no stroke, or MI. Thirty-day outcomes showed no deaths, MI, stroke, or repeat intervention. Angiographic outcomes showed no thrombosis/occlusion/kinking/torsion of the piggyback anastomosis. Mean follow-up time was 11.4 months. At 2-year follow-up, there were no deaths, stroke, MI, MACCE, or repeat intervention.
CONCLUSIONS: Piggyback anastomosis technique, provide good mid-term clinical outcomes with no reintervention or stroke.
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