title: Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow.
abstract: BACKGROUND
  End-to-side anastomoses to connect the distal end of the great saphenous vein (GSV) to small target coronary arteries are commonly performed in sequential coronary artery bypass grafting (CABG). However, the oversize diameter ratio between the GSV and small target vessels at end-to-side anastomoses might induce adverse hemodynamic condition. The purpose of this study was to describe a distal end side-to-side anastomosis technique and retrospectively compare the effect of distal end side-to-side versus end-to-side anastomosis on graft flow characteristics.
  
  
  METHODS
  We performed side-to-side anastomoses to connect the distal end of the GSV to small target vessels on 30 patients undergoing off-pump sequential CABG in our hospital between October 2012 and July 2013. Among the 30 patients, end-to-side anastomoses at the distal end of the GSV were initially performed on 14 patients; however, due to poor graft flow, those anastomoses were revised into side-to-side anastomoses. We retrospectively compared the intraoperative graft flow characteristics of the end-to-side versus side-to-side anastomoses in the 14 patients. The patient outcomes were also evaluated.
  
  
  RESULTS
  We found that the side-to-side anastomosis reconstruction improved intraoperative flow and reduced pulsatility index in all the 14 patients significantly. The 16 patients who had the distal end side-to-side anastomoses performed directly also exhibited satisfactory intraoperative graft flow. Three-month postoperative outcomes for all the patients were satisfactory.
  
  
  CONCLUSIONS
  Side-to-side anastomosis at the distal end of sequential vein grafts might be a promising strategy to connect small target coronary arteries to the GSV.
authors.forename: Haitao
authors.initials: H
authors.lastname: Li
authors.forename: Baodong
authors.initials: B
authors.lastname: Xie
authors.forename: Chengxiong
authors.initials: C
authors.lastname: Gu
authors.forename: Mingxin
authors.initials: M
authors.lastname: Gao
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.forename: Jiayang
authors.initials: J
authors.lastname: Wang
authors.forename: Longsheng
authors.initials: L
authors.lastname: Dai
authors.affiliation: Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China. heartyuyang@hotmail.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome