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Off-pump coronary artery bypass may decrease the patency of saphenous vein grafts
1Department of Thoracic and Cardiovascular Surgery, Clinical Research Institute, Seoul National University Hospital, Korea. kimkb@snu.ac.kr
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Off-pump coronary artery bypass grafting (OPCAB) showed lower saphenous vein graft (SVG) patency compared to arterial grafts and conventional methods. Perioperative anticoagulant therapy may be beneficial for OPCAB patients using SVG.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Outcomes
Background:
- Concerns exist regarding hypercoagulable status post-off-pump coronary artery bypass grafting (OPCAB).
- This status may compromise anastomosis patency after OPCAB procedures.
- Assessing graft patency differences among various bypass techniques is crucial.
Purpose of the Study:
- To compare 1-year graft patency after OPCAB versus conventional CABG and on-pump beating CABG.
- To evaluate differences in patency rates among various graft conduits (arterial vs. saphenous vein grafts) across the three surgical groups.
Main Methods:
- Retrospective analysis of 122 OPCAB (group I), 65 conventional CABG (group II), and 19 on-pump beating CABG (group III) cases.
- Coronary angiography (CAG) performed postoperatively and at 1 year for OPCAB; at 1 year for CABG groups.
- Graft patency assessed as excellent (A), fair (B), or occluded (O).
Main Results:
- OPCAB: 1-year patency was 97.8% for arterial grafts and 67.9% for saphenous vein grafts (SVG).
- Conventional CABG: 1-year patency was 93.5% for arterial grafts and 88.3% for SVG.
- On-pump beating CABG: 1-year patency was 100% for arterial grafts and 86.8% for SVG.
Conclusions:
- SVG patency after OPCAB was significantly lower than arterial grafts early postoperatively and at 1 year.
- 1-year SVG patency was significantly lower in OPCAB compared to conventional CABG and on-pump beating CABG.
- Specific perioperative anticoagulant therapy may be advisable for OPCAB patients receiving SVG.
Background:
There is concern that a hypercoagulable status is caused after coronary artery bypass grafting without cardiopulmonary bypass (off-pump coronary artery bypass grafting, or OPCAB) and may potentially endanger the patency of the anastomosis. The aims of this study were: (1) to compare 1-year graft patency after OPCAB with that of conventional coronary artery bypass grafting (CABG) and that of on-pump beating CABG; and (2) to demonstrate any differences in patency of various conduits among the three groups.
Methods:
We analyzed the results of 122 consecutive OPCAB cases (group 1) compared with those of 65 consecutive conventional CABG cases (group II) and those of 19 consecutive on-pump beating CABG cases (group III). In group I, coronary angiography (CAG) was performed immediately postoperatively and 1 year after surgery. In groups II and III, CAG was performed 1 year after surgery. Graft patency was graded as grade A (excellent), grade B (fair), or grade O (occluded).
Results:
The average number of distal anastomoses in groups I, II, and III were 3.1 +/- 1.1, 3.7 +/- 0.9, and 3.6 +/- 0.9, respectively. In group I, postoperative CAG was performed in 92% of patients (112/122) before discharge. The patency rate (grade A + B) was 96.4% (162/168) for arterial grafts, and 85.6% (160/187) for saphenous vein grafts (SVG). One-year follow-up CAG was performed in 74% of patients (90/122). The patency rate was 97.8% (132/135) for arterial grafts and 67.9% (106/156) for SVG. In group II, 1-year follow-up CAG was performed in 65% of patients (42/65). The patency rate (grade A + B) was 93.5% (43/46) for arterial grafts and 88.3% (98/111) for SVG. In group III, 1-year follow-up CAG was performed in 89% of patients (17/19). The patency rate (grade A + B) was 100% (19/19) for arterial grafts and 86.8% (33/38) for SVG.
Conclusions:
Our results demonstrate that the patency rate ot SVG after OPCAB was significantly lower than that of arterial grafts in the early postoperative CAG (p < 0.001), and was also significantly lower than those of SVG of group II (p < 0.001) and group III (p < 0.01) in the postoperative 1-year CAG, although there was no significant difference in 1-year patency of arterial grafts among the three groups. Our data suggest that a specific perioperative anticoagulant therapy may be advisable in patients undergoing OPCAB with SVG.