Intermediate-term patency of saphenous vein graft with a clampless hand-sewn proximal anastomosis device after off-pump coronary bypass grafting.
BACKGROUND
To avoid complications related to aortic manipulation, devices were developed to perform clampless anastomosis. However, there are few studies concerning the late patency of the graft. The aims of this study were to investigate the patency rate of saphenous vein (SV) graft after off-pump coronary artery bypass grafting (OPCAB) and to evaluate the influence of a clampless hand-sewn proximal anastomosis on late graft patency.


METHODS
Patients (n = 232) were enrolled who underwent OPCAB with SV grafts from 2004 to 2007 and had follow-up angiography. For proximal anastomoses, a clampless device was used in 73 (group A; HEARTSTRING [Guidant Corporation, Santa Clara, CA] in 54, Enclose II [Novare Surgical Systems, Inc, Cupertino, CA] in 19), and partial clamping was used in 159 (group B). The proximal anastomosis procedure was modified according to the results of epiaortic ultrasonography. Coronary angiography was performed early (11.8 +/- 10.4 days) and one-year postoperatively (n = 180, 371.5 +/- 102.6 days).


RESULTS
There were no significant differences in patient characteristics between the two groups except for a higher reoperation rate in group A. The overall SV patency rate at the early and one-year postoperative angiography was 95.7% and 83.0%, respectively. The patency rates were similar between the two groups (early: 97.3% vs 98.1%, p = 0.729; 1 year: 87.0% vs 81.3%, p = 0.316). There was also no significant difference in the target vessel revascularization rate during follow-up (6.8% vs 10.1%, p = 0.623).


CONCLUSIONS
Intermediate-term angiographic follow-up demonstrate an acceptable SV patency rate after OPCAB. The SV patency rate with a clampless device for proximal anastomosis is comparable with that with partial clamping during the first postoperative year.
Shimokawa
Tomoki
T
Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. tshimokawa-circ@umin.ac.jp
Manabe
Susumu
S
Sawada
Takahiro
T
Matsuyama
Shigefumi
S
Fukui
Toshihiro
T
Takanashi
Shuichiro
S
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D017023:Coronary Angiography / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency / Q000502:physiology*