Distal Anastomosis Support for Coronary Artery Bypass Grafting: A New Surgical Technique and Current Outcomes

Saphenous vein graft (SVG) failure remains the Achilles' heel of coronary artery bypass grafting (CABG) and grafts performed on the right coronary artery (RCA) system always have the worst patency compared with those performed on the left coronary system. The aim of this study was to introduce the distal anastomoses support (DAS) procedure and investigate the effect of DAS on the mid-term graft patency of SVG-PDA.

Between May and September 2013, 100 patients with an RCA severe lesion who underwent isolated OPCABG (CABG alone group, n=50) or CABG with DAS for anastomoses of SVG-PDA (CABG plus DAS group, n=50) were evaluated retrospectively.

Patency rates of SVG-PDA at two years were significantly higher in the CABG plus DAS group compared to the CABG alone group (94.0% vs 74.0%, p = 0.006). However, there was no significant difference between the two groups with regard to freedom from MACCE at two years (92.0±3.8% versus 82.0±5.4%, p=0.08). No death occurred in both groups, and freedom from angina at two years did not differ significantly between two groups (80.0% vs 92.0%, p=0.62). In multivariate logistic regression analysis, diffuse disease was the independent predictor of graft occlusion (OR=11.05, 95% CI 2.14-57.12, p=0.004), but concomitant DAS (OR=0.04, 95% CI 0.003-0.350, p=0.004), proximal stenosis > 75% (OR=0.09, 95% CI 0.02-0.50, p=0.006), and male gender (OR=0.05, 95% CI 0.007-0.301, p=0.001) were protective factors.

Concomitant DAS could improve mid-term patency of SVG-PDA. Adding the DAS procedure to CABG may be a new choice for patients with an RCA severe lesion.