Is Sequential Bypass Grafting on the Beating Heart Safe?
For coronary revascularization, some surgeons prefer to operate without the pump on the beating heart (OPCABG). In addition to the internal mammary artery to the left anterior descending coronary artery (LIMA-LAD), a sequential reversed saphenous vein graft (rSVG) is used to revascularize the lateral, inferior and posterior myocardium with a single proximal aortic anastomosis in order to minimize aortic manipulation.
Surgeons at Jefferson Medical School in Philadelphia retrospectively examined and summarized a series of their OPCAB cases, and evaluated distal conduit blood flow. Studied were 175 patients on whom OPCAB was performed with 1 IMA graft and 1 sequential rSVG performed by a single surgeon. The average number of grafts per patient was 3.4. Flow was measured in each segment of the sequential graft using a Transonic Flowmeter.
Measurements showed that mean flow through the distal segment of the sequential venous bypass was 36 ml/min. This was found not to be significantly influenced by the number of proximal coronary anastomoses, nor by the size of the proximal coronary bed. There was no 30-day mortality and stroke rate; there was a 29 percent incidence of postoperative atrial fibrillation in patients with normal baseline sinus rhythm, but no myocardial failure or renal failure requiring dialysis.
Researchers concluded that OPCAB using sequential reversed saphenous vein grafts (rSVG) is safe, and regional coronary blood flow is not compromised by the creation of sequential anastomoses.