Background: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass graft surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose the other conduit materials to revascularize the LAD. The purpose of this study was to explore the difference of different conduit materials used for LAD in the parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.
Methods: We retrospectively collected the data of 410 patients who undergoing isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the left descending artery (LAD) revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA)group(n=333), a right IMA group (n=34) and a great saphenous vein (SVG) group (n=43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates.
Results: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume(37.15±23.29vs29.71±20.94ml/min, P=0.036),however, a lower pulsatility index (2.07±0.62vs 2.65±1.01,P<0.001).There was no significant difference between the two groups in DF(P>0.05).Compared with the RIMA-LAD group, the SVG-LAD group just had a lower pulsatility index(2.07±0.62vs 2.56±0.96,P=0.029).However, there was no significant difference between the two groups in MGF and DF(P>0.05).Compared with the LIMA-LAD group, the RIMA-LAD group had a bit lower DF(70.76±11.87vs74.06±7.09,P=0.018),while there was no difference in MGF and PI between the two groups(P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), the RIMA-LAD group was 97.06% (33/34), and the SVG-LAD group was 100%. There was no difference among the three groups in patency rate(P=0.405).
Conclusions: We conclude that in patients whose LIMA cannot be used,the in-suit RIMA and the SVG are comparable and even better than the LIMA in the blood flow parameters measured by TTFM. In our study,the early patency before discharge of RIMA-LAD and SVG-LAD are comparable with the LIMA-LAD.