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Updated: Jun 6, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Sequential bypass on the beating heart can be achieved without compromising patient safety or regional myocardial
1Department of Surgery, Jefferson Health System, Philadelphia, Pennsylvania, USA. robert.quigley@internationalsos.com
Insights
This study shows that using a sequential reversed saphenous vein graft (rSVG) with an internal mammary artery (IMA) graft for off-pump coronary artery bypass grafting (OPCABG) is safe. This technique effectively revascularizes the heart without compromising blood flow, offering a less invasive option.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Coronary Artery Bypass Grafting
Background:
- Off-pump coronary artery bypass grafting (OPCABG) is preferred by some surgeons to minimize aortic manipulation.
- Sequential reversed saphenous vein grafts (rSVG) offer a method for multi-vessel revascularization with a single aortic anastomosis.
Purpose of the Study:
- To evaluate the safety and efficacy of combining an internal mammary artery (IMA) graft with a sequential rSVG for OPCABG.
- To assess distal conduit blood flow in sequential rSVG grafts during OPCABG.
Main Methods:
- Retrospective review of 175 consecutive OPCABG patients undergoing 1 IMA and 1 sequential rSVG.
- Flow rates in sequential rSVG segments measured using a Transonic Flowmeter.
- Patients received postoperative clopidogrel for 6 weeks.
Main Results:
- Mean distal flow in sequential rSVG was 36 ml/min, unaffected by proximal anastomoses or coronary bed size.
- Zero 30-day mortality and stroke rates (0/175).
- Postoperative atrial fibrillation occurred in 29% of patients with normal baseline rhythm; no myocardial infarctions or renal failure requiring dialysis.
Conclusions:
- The described OPCABG technique using IMA and sequential rSVG is safe and effective.
- Sequential anastomoses in rSVG do not compromise regional coronary blood flow.
- This approach represents a viable, less invasive option for complex coronary revascularization.
Abstract:
For some cardiac surgeons, operating on the beating heart is the preferred method of coronary revascularization. In an effort to minimize manipulation of the aorta, we have used, in addition to an internal mammary artery (IMA) graft to the left anterior descending (LAD) coronary artery, a sequential reversed saphenous vein graft (rSVG) to revascularize the lateral, inferior, and posterior myocardium with a single proximal aortic anastomosis. In this report, we retrospectively summarize a recent series of off-pump coronary bypass grafting (OPCABG) cases, including the evaluation of distal conduit blood flow. Between January 1, 2005, and January 1, 2007, a consecutive series of 175 patients underwent OPCABG with 1 IMA graft and 1 sequential rSVG performed by a single surgeon (RLQ). The average number of grafts/patient was 3.4 (range, 3-5). Flow rates were measured in each segment of the sequential graft using a Transonic Flowmeter (HT314, Transonic Systems Inc, Ithaca, NY). All patients were given PO clopidogrel (75 mg/d) for 6 weeks beginning on postoperative day #1. Mean flow through the distal segment of the sequential venous bypass was 36 ml/min, which was not significantly influenced by the number of proximal coronary anastomoses nor by the size of the proximal coronary bed. The 30-day mortality and stroke rate was 0% (0/175). The incidence of postoperative atrial fibrillation in those patients with normal baseline sinus rhythm was 29% (49/169). No postoperative myocardial infarctions [enzyme/electrocardiographic (ECG) criteria] nor renal failure requiring dialysis occurred. As the complexity of the surgical candidate continues to increase, less invasive approaches to coronary revascularization will prevail. The results of this retrospective study indicate that this technique is safe, and that regional coronary blood flow is not compromised by the creation of sequential anastomoses.
