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[Result of sequential coronary artery bypass grafting only with arterial grafts]
Insights
Sequential bypass grafting using only arterial grafts offers excellent patency rates and reduced operating times for coronary artery bypass grafting (CABG) patients with multiple vessel disease.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty indications are expanding, leading to more complex surgical cases.
- Coronary artery bypass grafting (CABG) exclusively with arterial grafts is a standard approach.
- Sequential bypass grafting is employed to address multi-vessel coronary artery disease.
Purpose of the Study:
- To evaluate the efficacy and outcomes of sequential versus non-sequential CABG using only arterial grafts.
- To compare graft patency rates and operative times between the two surgical techniques.
Main Methods:
- A retrospective study of 120 patients undergoing CABG with arterial grafts between January 1991 and November 1993.
- Comparison of a sequential bypass group (n=20) against a non-sequential group (n=100).
- Analysis of graft patency, in-hospital mortality, and operative parameters including cardiopulmonary bypass and aortic cross-clamp times.
Main Results:
- The sequential bypass group demonstrated a high patency rate of 98% (39/40 branches).
- Specific sequential graft patency rates included 96% for left internal thoracic artery (LITA) and 100% for right gastroepiploic artery (RGEA).
- Non-sequential CABG had a 98% patency rate (248/253), with lower rates for RITA grafts (97%).
- In-hospital mortality was nil in the sequential group versus 3% in the non-sequential group.
- Sequential bypass surgery resulted in shorter operation, extracorporeal circulation, and aortic cross-clamp times for two and three vessel bypasses.
Conclusions:
- Sequential bypass grafting with arterial grafts shows favorable patency rates.
- The sequential method can reduce operative times in CABG.
- Sequential bypass grafting is a useful technique for arterial CABG, particularly in multi-vessel disease.
Abstract:
The indication of percutaneous transluminal coronary angioplasty is getting wide, and surgical case is getting more severe and more serious. We have, as a rule, performed bypass surgery only with arterial grafts and we have conducted sequential bypass surgery to cope with multiple vessel disease. Coronary artery bypass grafting (CABG) only with arterial grafts was performed in 120 patients from January 1991 to November 1993. Comparison was made between sequential group (n = 20 cases) and non-sequential group (n = 100 cases). The patency rate of sequential group was 98% (39 branches/40 branches). It was 96% (27/28) in the left internal thoracic artery (LITA) sequential group and 100% (12/12) in the right gastroepiplotic artery (RGEA) sequential group. There was no death. The patency rate of non-sequential group was 98% (248/253). It was 98% (95/97) in the LITA group, 97% (60/62) in the right internal thoracic artery (RITA) group, and 99% (93/94) in the RGEA group. Three patients (3%) died in hospital. Operation time, extracorporeal circulation time, and aortic crossclamp time was found to be shorter in the sequential group on two and three vessel bypass surgery. Because the patency rate of sequential bypass were favorable and the operating time could be reduced, sequential bypass method is thought to be usefull in CABG only with arterial grafts.