The side-to-side fashion for individual distal coronary anastomosis using venous conduit.

Abstract

Regarding to coronary artery bypass grafting (CABG), the end-to-side anastomosis (ESA) has been performed as a gold standard. Recently, the effectiveness of the distal side-to-side anastomosis (SSA) in CABG using internal mammary artery has been reported. The benefit of SSA comparing to ESA also has been disclosed by computing simulation. However, use of SSA by venous conduit for individual CABG has not been reported. In this study, we investigated feasibility of SSA. From January 2013 to October 2014, we conducted 114 CABGs. There were 92 venous distal anastomoses without sequential anastomotic site (61 SSA and 31 ESA). The anastomosis was evaluated before discharge and at 1year after the procedure by angiography or multi-detector row computed tomographic coronary angiography. The median values for time to anastomosis were 13min in the two group (p=0.89). There was no revision of anastomosis in both groups. Additional stitches for hemostasis were required significantly less in SSA than ESA (18.0 vs 45.2%, respectively, p<0.05). Early angiographic patency; 96.6% for SSA vs 93.5% for ESA (p=0.50), and percentage of good anastomotic figure; 91.2% for SSA vs 87.1% for ESA (p=0.54) were similar in both groups. The angiographic patency at 1year were 92.9% for SSA and 81.0% for ESA (p=0.16). There was no predictive factor for early and late graft failure. Our study showed feasibility of SSA using venous conduit in individual CABG based on early and mid-term angiographic results. This anastomotic fashion is easy to perform and maybe beneficial in blood flow pattern.