Complete Myocardial Revascularization Utilizing Parallel Sequential Anastomoses.
- Author:
Kay Hyun PARK
1
;
Kwhan Mien KIM
;
Tae Gook JUN
;
Jhin Gook KIM
;
Young Mog SHIM
;
Pyo Won PARK
;
Hurn CHAE
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Korea.
- Publication Type:Original Article
- Keywords:
Coronary artery surgery;
Saphenous vein
- MeSH:
Cardiopulmonary Bypass;
Coronary Artery Bypass;
Coronary Disease;
Coronary Stenosis;
Follow-Up Studies;
Humans;
Incidence;
Myocardial Infarction;
Myocardial Revascularization*;
Perfusion;
Postoperative Complications;
Saphenous Vein;
Transplants;
Veins
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1997;30(7):647-655
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
We evaluated the feasibility and safety of this method by reviewing the early outcome of the patients who underwent coronary artery bypass grafting(CABG) utilizing parallel sequential anastomoses with saphenous vein grafts, comparing with the outcome of the patients revascularized with grafts having only single distal anastomosis. During the one-year period of 1995, a total of 79 patients underwent isolated CABG, among whom 39 patients with sequential vein grafts(sequential group) and 40 patients without sequential grafts(non-sequential group). There was no difference between the two groups in terms of preoperative status, except in the extent of the coronary disease; 87.2% of the sequential group and 45.0% of the non-sequential group had left main and/or triple vessel involvement. 318 distal coronary anastomoses were done; 198 for the sequential group(5.1/patient) and 120 for the non-sequential group(3.0/patient). In the sequential group, the mean durations of cardiopulmonary bypass and aortic clamp per one distal anastomosis were 33.5 and 21.1 minutes, respectively. In the non-sequential group, these were 41.8 and 22.7 minutes. There were two operative deaths, both in the non-sequential group. There was no difference in the incidence of postoperative complications including myocardial infarction. During the follow-up period(2 to 15 months), 8 patients(3 in the sequential and 5 in the non- sequential group) complained of residual or recurrent angina. Comparison of preoperative and postoperative 201Thallium myocardial perfusion scans in 30 patients showed improved or normal perfusion reserve in 83.3% of segments bypassed with sequential grafts and 82.5% of segments bypassed with non-sequential graft(s). These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft. These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft.
