Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow

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• 作者：Haitao Li (4)
  Baodong Xie (5)
  Chengxiong Gu (4)
  Mingxin Gao (4)
  Fan Zhang (4)
  Jiayang Wang (4)
  Longsheng Dai (4)
  Yang Yu (4)
  
  4. Department of Cardiac Surgery ; Beijing An Zhen Hospital ; Capital Medical University ; Beijing ; 100029 ; China
  5. Department of cardiovascular surgery ; The second affiliated hospital of Harbin Medical University ; 246 Xuefu Road ; Harbin ; Heilongjiang ; 150086 ; China
  
• 关键词：Coronary artery bypass grafts ; venous graft ; off ; pump surgery
• 刊名：BMC Cardiovascular Disorders
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：439 KB
• 参考文献：1. Spivack, DE, Kelly, P, Gaughan, JP, van Bemmelen, PS (2012) Mapping of superficial extremity veins: normal diameters and trends in a vascular patient-population. Ultrasound Med Biol 38: pp. 190-194 CrossRef
  2. Longest, PW, Kleinstreuer, C (2003) Particle-hemodynamics modeling of the distal end-to-side femoral bypass: effects of graft caliber and graft-end cut. Med Eng Phys 25: pp. 843-58 CrossRef
  3. Ghista, DN, Kabinejadian, F (2013) Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review. Bio Medical Engineering On Line 12: pp. 129
  4. Keynton, RS1, Evancho, MM, Sims, RL, Rittgers, SE (1999) The effect of graft caliber upon wall shear within in vivo distal vascular anastomoses. J Biomech Eng 121: pp. 79-88 CrossRef
  5. Qiao, A, Liu, Y (2006) Influence of graft-host diameter ratio on the hemodynamics of CABG. Biomed Mater Eng 16: pp. 189-201
  6. Sewell, WH (1974) Improved coronary vein graft patency rates with side-to-side anastomoses. Ann Thorac Surg 17: pp. 538-544 CrossRef
  7. Bonert, M, Myers, JG, Fremes, S, WILLIAMS, J, ETHIER, CR (2002) A Numerical Study of Blood Flow in Coronary Artery Bypass Graft Side-to-Side Anastomoses. Ann Biomed Eng 30: pp. 599-611 CrossRef
  8. Kabinejadian, F, Chua, LP, Ghista, DN, Sankaranarayanan, M, Tan, YS (2010) A novel coronary artery bypass graft design of sequential anastomoses. Ann Biomed Eng 38: pp. 3135-3150 CrossRef
  9. Kabinejadian, F, Ghista, DN (2012) Compliant model of a coupled sequential coronary arterial bypass graft: effects of vessel wall elasticity and non-Newtonian rheology on blood flow regime and hemodynamic parameters distribution. Med Eng Phys 34: pp. 860-872 CrossRef
  10. Frauenfelder, T, Boutsianis, E, Schertler, T, Husmann, L, Leschka, S, Poulikakos, D, Marincek, B, Alkadhi, H (2007) Flow and wall shear stress in end-to-side and side-to-side anastomosis of venous coronary artery bypass grafts. BioMed Eng OnLine 6: pp. 35-48 CrossRef
  11. Sankaranarayanan, M, Ghista, DN, Chua, LP, Tan, YS, Sundaravadivelu, K, Kassab, GS Blood flow in an out-of-plane aortag-left coronary sequential bypass graft. In: Guccione, JM, Kassab, GS, Ratcliffe, M eds. (2010) Computational Cardiovascular Mechanics: Modeling and Applications in Heart Failure. Springer-Verlag, New York, pp. 277-297 CrossRef
  12. Nabuchi, A, Kurata, A, Tsukuda, K, Tajima, H, Kim, K (2000) Side-to-Side Anastomosis in Off-Pump Coronary Artery Bypass Grafting. Asian Cardiovasc Thorac Ann 8: pp. 394-397 CrossRef
  13. Song, MH, Tokuda, Y, Ito, T (2007) Revival of the side-to-side approach for distal coronary anastomosis. J Cardiothorac Surg 2: pp. 2-7 CrossRef
  14. Kieser, TM, FitzGibbon, GM, Keon, WJ (1986) Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovasc Surg 91: pp. 767-772
  15. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2261/14/65/prepub
  
• 刊物主题：Cardiology; Cardiac Surgery; Angiology; Blood Transfusion Medicine; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2261

文摘

Background End-to-side anastomoses to connect the distal end of the great saphenous vein (GSV) to small target coronary arteries are commonly performed in sequential coronary artery bypass grafting (CABG). However, the oversize diameter ratio between the GSV and small target vessels at end-to-side anastomoses might induce adverse hemodynamic condition. The purpose of this study was to describe a distal end side-to-side anastomosis technique and retrospectively compare the effect of distal end side-to-side versus end-to-side anastomosis on graft flow characteristics. Methods We performed side-to-side anastomoses to connect the distal end of the GSV to small target vessels on 30 patients undergoing off-pump sequential CABG in our hospital between October 2012 and July 2013. Among the 30 patients, end-to-side anastomoses at the distal end of the GSV were initially performed on 14 patients; however, due to poor graft flow, those anastomoses were revised into side-to-side anastomoses. We retrospectively compared the intraoperative graft flow characteristics of the end-to-side versus side-to-side anastomoses in the 14 patients. The patient outcomes were also evaluated. Results We found that the side-to-side anastomosis reconstruction improved intraoperative flow and reduced pulsatility index in all the 14 patients significantly. The 16 patients who had the distal end side-to-side anastomoses performed directly also exhibited satisfactory intraoperative graft flow. Three-month postoperative outcomes for all the patients were satisfactory. Conclusions Side-to-side anastomosis at the distal end of sequential vein grafts might be a promising strategy to connect small target coronary arteries to the GSV.