Immediate results of off-pump versus on-pump coronary artery bypass grafting using autoarterial conduits in situ and Y-graft configurations

Aim. To compare the immediate results of off-pump versus on-pump coronary artery bypass grafting (CABG) using autoarterial conduits.Material and Methods. From January 2018 to September 2021, 178 coronary artery bypass grafting operations using autoarterial conduits were performed in the Department No. 1 of the Federal Center for Cardiovascular Surgery (Krasnoyarsk). The operation was performed on a beating heart in 88 patients (group 1) and using cardiopulmonary bypass in 90 patients (group 2). The majority of patients were males in both groups: 76 (86.3%) and 75 (83.3%) patients (p = 0.287). The patients were comparable in age (61.6 ± 7.7 and 60.2 ± 7.5 years, p = 0.237), body mass index (30.9 ± 5.7 and 29.8 ± 5, p = 0.18), and the presence of concomitant diabetes mellitus (30 (34%) and 19 (21.1%), p = 0.052). There were significantly more patients with hemodynamically significant lesions of the brachiocephalic arteries in group 1 (27 (30.7%) versus 13 (14.4%), p = 0.009) and calcification of the ascending aorta (24 (27.3%) versus 11 (12.2%), p = 0.011). The number of hemodynamically significant affected coronary arteries did not differ between the groups: 2.6 ± 0.7 versus 2.5 ± 0.5 (p = 0.393).Results. Both internal thoracic arteries were used in situ or in the form of Y-grafts in both groups depending on the number of distal anastomoses. Hospital mortality was 2 patients (2.2%), both from group 2 (p = 0.161). The groups were comparable in the number of distal anastomoses (2.7 ± 0.7 and 2.7 ± 0.6, p = 0.532), the incidence of acute perioperative myocardial infarction (1 (1.1%) and 1 (1.1%), p = 0.987), neurological complications (1 (1.1%) and 2 (2.2%), p = 0.576), and bleeding requiring resternotomy (1 (1.1%) and 3 (3.3%), p = 0.325). Deep sternal wood infection was absent in both groups.Conclusion. Autoarterial coronary artery bypass grafting is an effective method of myocardial revascularization in both the beating heart surgery and in cardiopulmonary bypass conditions. This method should be considered an operation of choice for patients with multiple coronary artery disease. The performance of operations in the conditions of cardiopulmonary bypass does not affect the increase in the number of cardiocerebral events in the postoperative period. </jats:p

Immediate results of using both internal thoracic arteries for coronary artery bypass surgery in patients with ischemic artery disease

Objective: To compare direct results of «in situ» and Y-graft bimammary autoarterial bypass in patients having coronary artery disease.Methods:  From January 2018 to November 2020, 107 patients having ischemic artery disease undergone coronary artery bypass surgery in the Cardiac Surgery Department No.1 of the Federal State Budgetary Institution "Federal Center for Cardiovascular Surgery" of the Ministry of Health of the Russian Federation (Krasnoyarsk). The distribution of the groups was carried out in a 3:1 ratio: in the first group (24 patients) both internal thoracic arteries were used for myocardial revascularization according to the «in situ» technique, in the second group (composite bypass surgery) (83 patients) the right internal thoracic artery was anastomosed with a free graft with the left internal thoracic artery (Y- graft).Results: There were no cases of hospital mortality. The duration of operations in the composite bypass group was significantly higher than in the «in situ» group (126.4  minutes ± 20.1 minutes versus 172.3 minutes ± 27.1 minutes, p = 0.038). The reason for extra time is the necessity to put a large number of distal anastomoses. Bleeding in the early postoperative period was observed only in one case (1.2%) in the composite bypass group. Perioperative myocardial infarctions, neurological complications, and deep wound infection of the sternum weren't observed in any group. One patient from the «in situ» group (4.2%) and one patient from the composite bypass grafting group (1.2%), experienced the postoperative period complicated by a superficial wound infection in the area of the sternotomy access (p = 0.649). In the «in situ» group, average blood flow velocity according to flowmetry data was 32 ml / min ± 8.1 ml / min, and in the composite shunting group it counted 51.8 ml / min ± 12.3 ml / min, p = 0.001.Conclusions. Using both internal thoracic arteries for coronary artery bypass surgery provides a favorable effect of surgical treatment in the postoperative period. This operation technique can be safely performed with low mortality rate and less complications. It may be associated with improved long-term patient survival; but this requires further analysis of the study results in a longer period.</jats:p