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Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods.
Heart Surg Forum. 2002; 5(2):114-8.HS

Abstract

BACKGROUND

Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods.

METHODS

Between March 2000 and April 2001, 120 patients underwent OPCAB with this technique. The age of patients ranged from 47 to 86 years, with a mean age of 65.7 +/- 8.7 years. On average, 3.12 +/- 0.77 grafts per patient were completed. More than 4 distal anastomoses were performed in 32 patients (27%). As in-situ grafts, 140 internal thoracic arteries (ITAs) and 9 gastroepiploic arteries were used. The radial artery (RA) was used as a Y composite graft in 91 patients, as an I composite graft in 25, and as a K composite graft in 2. Sequential bypass grafting was performed using the RA in 60 patients, the saphenous vein (SV) in 6, the ITA in 4, and the gastroepiploic artery (GEA) in 3. Arterial grafts were used in 92% (345/374) of total bypass grafts. Distal anastomosed sites were 119 left anterior descending arteries (LADs) (32%), 90 posterolateral branches (24%), 64 posterior descending arteries (17%), 49 diagonal branches (13%), 39 obtuse marginal branches (10%), and 13 right coronary arteries (3.5%).

RESULTS

There was no operative death or stroke. Early postoperative angiography revealed 95.5% (321/336) graft patency with 100% patency (119/119) of ITA to LAD grafts. Graft patency of the ITAs and RAs (98.5% and 95.9%) were significantly better than that of the GEA (79.0%, p = 0.0064 and p = 0.030) and saphenous vein (82.3%, p = 0.011 and p = 0.048).

CONCLUSION

OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency.

Authors+Show Affiliations

Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. jkobayas@hsp.ncvc.go.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12114124

Citation

Kobayashi, Junjiro, et al. "Multiple Off-pump Coronary Revascularization With "aorta No-touch " Technique Using Composite and Sequential Methods." The Heart Surgery Forum, vol. 5, no. 2, 2002, pp. 114-8.
Kobayashi J, Sasako Y, Bando K, et al. Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods. Heart Surg Forum. 2002;5(2):114-8.
Kobayashi, J., Sasako, Y., Bando, K., Niwaya, K., Tagusari, O., Nakajima, H., Nakamura, Y., Ishida, M., & Kitamura, S. (2002). Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods. The Heart Surgery Forum, 5(2), 114-8.
Kobayashi J, et al. Multiple Off-pump Coronary Revascularization With "aorta No-touch " Technique Using Composite and Sequential Methods. Heart Surg Forum. 2002;5(2):114-8. PubMed PMID: 12114124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods. AU - Kobayashi,Junjiro, AU - Sasako,Yoshikado, AU - Bando,Ko, AU - Niwaya,Kazuo, AU - Tagusari,Osamu, AU - Nakajima,Hiroyuki, AU - Nakamura,Yoshitsugu, AU - Ishida,Michiko, AU - Kitamura,Soichiro, PY - 2001/06/27/accepted PY - 2002/7/13/pubmed PY - 2002/9/13/medline PY - 2002/7/13/entrez SP - 114 EP - 8 JF - The heart surgery forum JO - Heart Surg Forum VL - 5 IS - 2 N2 - BACKGROUND: Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods. METHODS: Between March 2000 and April 2001, 120 patients underwent OPCAB with this technique. The age of patients ranged from 47 to 86 years, with a mean age of 65.7 +/- 8.7 years. On average, 3.12 +/- 0.77 grafts per patient were completed. More than 4 distal anastomoses were performed in 32 patients (27%). As in-situ grafts, 140 internal thoracic arteries (ITAs) and 9 gastroepiploic arteries were used. The radial artery (RA) was used as a Y composite graft in 91 patients, as an I composite graft in 25, and as a K composite graft in 2. Sequential bypass grafting was performed using the RA in 60 patients, the saphenous vein (SV) in 6, the ITA in 4, and the gastroepiploic artery (GEA) in 3. Arterial grafts were used in 92% (345/374) of total bypass grafts. Distal anastomosed sites were 119 left anterior descending arteries (LADs) (32%), 90 posterolateral branches (24%), 64 posterior descending arteries (17%), 49 diagonal branches (13%), 39 obtuse marginal branches (10%), and 13 right coronary arteries (3.5%). RESULTS: There was no operative death or stroke. Early postoperative angiography revealed 95.5% (321/336) graft patency with 100% patency (119/119) of ITA to LAD grafts. Graft patency of the ITAs and RAs (98.5% and 95.9%) were significantly better than that of the GEA (79.0%, p = 0.0064 and p = 0.030) and saphenous vein (82.3%, p = 0.011 and p = 0.048). CONCLUSION: OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency. SN - 1098-3511 UR - https://www.unboundmedicine.com/medline/citation/12114124/Multiple_off_pump_coronary_revascularization_with_"aorta_no_touch_"_technique_using_composite_and_sequential_methods_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -