| Background and objective In recent years,the prevalence and mortality of cardiovascular disease in China still occupy the first place and show an upward trend,in which coronary artery disease(CAD)ranks second only to stroke,and its risk increases with the increase of age,and tends to be younger day by day.The management of CAD includes primary prevention strategies(such as smoking cessation,weight control,diet changes and proper physical exercise,etc.)and secondary prevention strategies(control of blood pressure,management of blood lipids and diabetes,and the use of antiplatelet drugs,?-blockers and renin-angiotensin-aldosterone system antagonists,etc.),and invasive revascularization was performed by percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG).With regard to the type of revascularization to be used(CABG or PCI),need to take into account the interaction of various factors in the decision-making process,including clinical manifestations,complications,cognitive status,life expectancy,etc.,in addition to patient preferences,the most important criteria are the predicted surgical mortality relative to the individual characteristics of the patient,the complexity of existing coronary anatomy or lesions,and the integrity of expected revascularization.At present,it has been confirmed that CABG is the gold standard treatment for patients with complex multi-vessel coronary artery stenosis or left main coronary artery disease.With the development of technology,the prognosis of patients undergoing coronary artery bypass grafting has been greatly improved,but graft patency is still the"Achilles heel"of this operation.First of all,the transplantation strategy from left internal mammary artery(LIMA)to left anterior descending(LAD)has been determined as the first choice for CABG,and it has been proved to have the best graft patency and good long-term clinical effect compared with other arteriovenous grafts.Secondly,although total arterial transplantation or bilateral internal mammary artery transplantation has received more and more attention in contemporary CABG,great saphenous vein grafts(SVG)are still the most commonly used grafts,accounting for about 80%of the total number of CABG grafts.Therefore,the patency of SVG has been paid more and more attention.With the accumulation of experience and a large number of experimental studies,it has been gradually found that the factors affecting the patency of CABG grafts include graft selection,surgical techniques,inherent morphological and functional characteristics of grafts and so on.Optimized acquisition operation,intraoperative preservation strategy and anastomosis technique have great influence on the patency of vein transplantation.Therefore,further research is needed to determine a more suitable method of great saphenous vein transplantation,so as to improve the safety and effectiveness of the operation.However,there are few studies on changeable surgical factors(such as anastomosis technique).Although sequential transplantation technology has been widely used in clinical practice,there is no clear argument about the choice of different techniques of SVG transplantation(single or sequential transplantation)in CABG.This study retrospectively analyzed the long-term follow-up results of patients after CABG,compared the long-term patency and prognosis of sequential and single saphenous vein graft after CABG,and discussed the effect of different anastomosis techniques on the patency of great saphenous vein graft after CABG.To provide objective basis for improving the long-term patency rate of bridging vessels.Methods Using the method of retrospective analysis,patients who were diagnosed as severe multi-vessel coronary artery stenosis and received simple CABG were selected from January 2010 to December2013 in our hospital.In strict accordance with the inclusion criteria and exclusion criteria,a total of191 patients were selected.All patients were treated with simple CABG for the first time.And the operation is performed by the same chief surgeon.The LAD was anastomosed with the distal LIMA in situ with LIMA-LAD alone.SVG was used in the rest of the coronary artery system for single or sequential transplantation of the distal aorta-SVG-coronary artery.According to the different anastomosis strategies of SVG,the patients were divided into 109 cases of sequential bridge group(9cases of double-branch bridge,88 cases of three-branch bridge,12 cases of four-branch bridge,a total of 330 branches)and 82 cases of single bridge group(4 cases of single root bridge,75 cases of double root bridges and 3 cases of three root bridges,with a total of 163 bridges).According to the location of different anastomoses of vein bridges,there are 109 proximal anastomosis,212 middle side anastomosis and 109 distal anastomosis of sequential bridge,163 proximal anastomosis and 163 distal anastomosis of single branch bridge.All patients underwent coronary angiography(CAG)or coronary computed tomographic angiography(CCTA)during 5-10 years(mean 6.5 years)after CABG.A total of 281 SVGs and 756 anastomoses were evaluated.A total of 281 SVG and 756 anastomoses were evaluated.The total patency rate of vein bridge and the patency rate of anastomosis at different positions were compared between the two groups.Results The long-term patency rate of SVG sequential bridge(82%)was higher than that of single-branch bridge(71.8%),and the difference was statistically significant(?~2=5.09,p=0.024).In terms of anastomosis in different positions,the patency rate of the middle side anastomosis of the sequential bridge(84.9%)was higher than that of the distal anastomosis of the single branch bridge(71.2%),and the difference was statistically significant(?~2=10.462,p=0.001).The patency rate of the anastomosis on the middle side of the sequential bridge(84.9%)was higher than that of the distal anastomosis of the sequential bridge(69.7%),and the difference was statistically significant(?~2=10.273,p=0.001).The patency rate of the proximal anastomosis of the sequential bridge(84.4%)was higher than that of the distal anastomosis of the sequential bridge(69.7%),and the difference was statistically significant(?~2=6.644,p=0.010).There was no significant difference in patency rate between the proximal anastomosis of sequential bridge and that of single bridge(p>0.05).There was no significant difference in the patency rate between the distal anastomosis of sequential bridge and the distal anastomosis of single branch bridge(p>0.05).Conclusion The long-term patency of sequential SVG after CABG was better than that of single SVG.In the anastomosis of different positions,the patency of the proximal anastomosis of the sequential bridge is better than that of the distal anastomosis of the sequential bridge.The patency of the side-to-side anastomosis of the sequential bridge is better than that of the distal end of the sequential bridge and the distal end of the single-branch bridge.In a word,the sequential transplantation of great saphenous vein has obvious advantages in the application of CABG and improves the long-term patency of SVG. |
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