Mid-term Outcomes of Left Internal Mammary Artery to Saphenous Vein Composite Grafts in Off-pump Coronary Artery Bypass Surgery for Elderly Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  MEIJu , TANGMin , LIUHao , DINGFang-bao , BAOChun-rong , MANan , ZHANGJun-wen

Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Coronary artery bypass grafting; Left internal mammary artery; Saphenous vein; Radial artery

DOI：

10.7507/1007-4848.20150079

Video：

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Objective To explore the mid-term outcomes achieved by using the left internal mammary artery to saphenous vein composite grafts in off-pump coronary artery bypass surgery (OPCAB) for elderly patients. Methods A total of 59 elderly patients (≥70 years old) underwent OPCAB by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) composite grafts in Xinhua Hospital between March 2006 and October 2012. There was 37 males and 22 females at age of 72.71±1.95 years. Twenty one patients used LIMA-SV composite grafts (LIMA-SV group), and 38 patients used LIMA-RA composite grafts (LIMA-RA group). Results All patients successfully underwent OPCAB with LIMA-SV or LIMA-RA composite grafts. There was one early death in the LIMA-RA group. No statistical differences in early postoperative outcomes were found between the two groups (P > 0.05). During a follow-up of 12 to 91 months, no patient occurred revascularization. There were no statistical differences in overall survival or graft patency rate, and 1 year, 3 years or 5 years survival rates between the two groups (P > 0.05). The patency rate of LIMA in each group was 100% respectively. There was also no statistical difference in overall patency rate of SV and RA between the two groups at the end of 1 year, 3 years or 5 years (P > 0.05). Conclusion Although artery grafts are the best choice for OPCAB, LIMA-SV composite grafts can be used as an alternative graft for elderly patients whose RA or right internal mammary artery is not possible or advisable.

Citation： JIANGZhao-lei, MEIJu, TANGMin, LIUHao, DINGFang-bao, BAOChun-rong, MANan, ZHANGJun-wen. Mid-term Outcomes of Left Internal Mammary Artery to Saphenous Vein Composite Grafts in Off-pump Coronary Artery Bypass Surgery for Elderly Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(4): 284-287. doi: 10.7507/1007-4848.20150079 Copy

1.	Likosky DS, Marrin CA, Caplan LR, et al.Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery.Stroke, 2003, 34(12):2830-2834.
2.	Mack MJ, Pfister A, Bachand D, et al.Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease.J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3.	Vallely MP, Potger K, McMillan D, et al.Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery.Heart Lung Circ, 2008, 17(4):299-304.
4.	Tatoulis J, Buxton BF, Fuller JA, et al.Long-term patency of 1108 radial arterial-coronary angiograms over 10 years.Ann Thorac Surg, 2009, 88(1):23-29.
5.	Halbersma WB, Arrigoni SC, Mecozzi G, et al.Four-year outcome of OPCAB no-touch with total arterial Y-graft:making the best treatment a daily practice.Ann Thorac Surg, 2009, 88(3):796-801.
6.	Kotoh K, Fukahara K, Doi T, et al.Predictors of early postoperative cerebral infarction after isolated off-pump coronary artery bypass grafting.Ann Thorac Surg, 2007, 83(5):1679-1683.
7.	Kim KB, Kang CH, Chang WI, et al.Off-pump coronary artery bypass with complete avoidance of aortic manipulation.Ann Thorac Surg, 2002, 74(4):S1377-S1382.
8.	Misfeld M, Brereton RJL, Sweetman EA, et al.Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation:meta-analysis of 11, 398 cases from 8 studies.J Thorac Cardiovasc Surg, 2011, 142(2):e7-e11.
9.	Lev-Ran O, Braunstein R, Sharony R, et al.No-touch aorta off-pump coronary surgery:the effect on stroke.J Thorac Cardiovasc Surg, 2005, 129(2):307-313.
10.	Misfeld M, Potger K, Ross DE, et al. "Anaortic" off-pump coronary artery bypass grafting significantly reduces neurological complications compared to off-pump and conventional on-pump surgery with aortic manipulation.Thorac Cardiovasc Surg, 2010, 58(7):408-414.
11.	武忠, 陈保俊, 张杰等.升主动脉不接触技术在非体外循环冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2010, 17(1):62-64.
12.	Elmistekawy EM, Gawad N, Bourke M, et al.Is bilateral internal thoracic artery use safe in the elderly?J Card Surg, 2012, 27(1):1-5.
13.	Achouh P, Boutekadjirt R, Toledano D, et al.Long-term (5-to 20-year) patency of the radial artery for coronary bypass grafting.J Thorac Cardiovasc Surg, 2010, 140(1):73-79.
14.	Schwann TA, Zacharias A, Riordan CJ, et al.Sequential radial artery grafts for multivessel artery bypass graft surgery:10-year survival andn angiography results.Ann Thorac Surg, 2009, 88(1):31-39.
15.	Dreifaldt M, Mannion JD, Bodin L, et al.The no-touch saphenous vein as the preferred second conduit for coronary artery bypass grafting.Ann Thorac Surg, 2013, 96(1):105-111.
16.	Song SW, Sul SY, Lee HJ, et al.Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients:A randomized controlled trial.Korean Circ J, 2012, 42(2):107-112.
17.	Hayward PAR, Gordon IR, Hare DL, et al.Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years:Results from the Radial Artery Patency and Clinical Outcomes trial.J Thorac Cardiovasc Surg, 2010, 139(1):60-67.
18.	Goldman S, Sethi GK, Holman W, et al.Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery.JAMA, 2011, 305(2):167-174.
19.	Glineur D, Boodhwani M, Poncelet A, et al.Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries.J Thorac Cardiovasc Surg, 2010, 140(3):639-645.
20.	Li J, Liu Y, Zheng J, et al.The patency of sequential and individual vein coronary bypass grafts:a systematic review.Ann Thorac Surg, 2011, 92(4):1292-1298.

1. Likosky DS, Marrin CA, Caplan LR, et al.Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery.Stroke, 2003, 34(12):2830-2834.
2. Mack MJ, Pfister A, Bachand D, et al.Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease.J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3. Vallely MP, Potger K, McMillan D, et al.Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery.Heart Lung Circ, 2008, 17(4):299-304.
4. Tatoulis J, Buxton BF, Fuller JA, et al.Long-term patency of 1108 radial arterial-coronary angiograms over 10 years.Ann Thorac Surg, 2009, 88(1):23-29.
5. Halbersma WB, Arrigoni SC, Mecozzi G, et al.Four-year outcome of OPCAB no-touch with total arterial Y-graft:making the best treatment a daily practice.Ann Thorac Surg, 2009, 88(3):796-801.
6. Kotoh K, Fukahara K, Doi T, et al.Predictors of early postoperative cerebral infarction after isolated off-pump coronary artery bypass grafting.Ann Thorac Surg, 2007, 83(5):1679-1683.
7. Kim KB, Kang CH, Chang WI, et al.Off-pump coronary artery bypass with complete avoidance of aortic manipulation.Ann Thorac Surg, 2002, 74(4):S1377-S1382.
8. Misfeld M, Brereton RJL, Sweetman EA, et al.Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation:meta-analysis of 11, 398 cases from 8 studies.J Thorac Cardiovasc Surg, 2011, 142(2):e7-e11.
9. Lev-Ran O, Braunstein R, Sharony R, et al.No-touch aorta off-pump coronary surgery:the effect on stroke.J Thorac Cardiovasc Surg, 2005, 129(2):307-313.
10. Misfeld M, Potger K, Ross DE, et al. "Anaortic" off-pump coronary artery bypass grafting significantly reduces neurological complications compared to off-pump and conventional on-pump surgery with aortic manipulation.Thorac Cardiovasc Surg, 2010, 58(7):408-414.
11. 武忠, 陈保俊, 张杰等.升主动脉不接触技术在非体外循环冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2010, 17(1):62-64.
12. Elmistekawy EM, Gawad N, Bourke M, et al.Is bilateral internal thoracic artery use safe in the elderly?J Card Surg, 2012, 27(1):1-5.
13. Achouh P, Boutekadjirt R, Toledano D, et al.Long-term (5-to 20-year) patency of the radial artery for coronary bypass grafting.J Thorac Cardiovasc Surg, 2010, 140(1):73-79.
14. Schwann TA, Zacharias A, Riordan CJ, et al.Sequential radial artery grafts for multivessel artery bypass graft surgery:10-year survival andn angiography results.Ann Thorac Surg, 2009, 88(1):31-39.
15. Dreifaldt M, Mannion JD, Bodin L, et al.The no-touch saphenous vein as the preferred second conduit for coronary artery bypass grafting.Ann Thorac Surg, 2013, 96(1):105-111.
16. Song SW, Sul SY, Lee HJ, et al.Comparison of the radial artery and saphenous vein as composite grafts in off-pump coronary artery bypass grafting in elderly patients:A randomized controlled trial.Korean Circ J, 2012, 42(2):107-112.
17. Hayward PAR, Gordon IR, Hare DL, et al.Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years:Results from the Radial Artery Patency and Clinical Outcomes trial.J Thorac Cardiovasc Surg, 2010, 139(1):60-67.
18. Goldman S, Sethi GK, Holman W, et al.Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery.JAMA, 2011, 305(2):167-174.
19. Glineur D, Boodhwani M, Poncelet A, et al.Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries.J Thorac Cardiovasc Surg, 2010, 140(3):639-645.
20. Li J, Liu Y, Zheng J, et al.The patency of sequential and individual vein coronary bypass grafts:a systematic review.Ann Thorac Surg, 2011, 92(4):1292-1298.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid-term Outcomes of Left Internal Mammary Artery to Saphenous Vein Composite Grafts in Off-pump Coronary Artery Bypass Surgery for Elderly Patients

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