Application Value Of Y-shaped Bridge With Great Saphenous Vein Branch Preserved In Coronary Artery Bypass Grafting

Objective Coronary artery bypass grafting is suitable for patients with coronary heart disease.The left internal mammary artery is the preferred bridge material during operation.However,due to the limited materials,it is usually used for the transplantation of the left anterior descending branch,while other target vessels often use the great saphenous vein.For saphenous vein bypass,there are two main anastomoses: single and sequential,which have been studied in clinical application.However,there is no report on the effect of preserving the natural Y-shaped bridge of the great saphenous vein branch in coronary artery bypass grafting.This paper summarizes 100 patients with coronary heart disease who underwent CABG by sequential anastomosis of great saphenous vein and Yshaped anastomosis with reserved branches.Through the measurement of venous bridge blood flow during operation and postoperative follow-up,the differences of bridge blood flow and p I value of different anastomosis methods,as well as the differences of medium and long-term patency rate of bridge blood vessels and improvement of cardiac function were observed and compared,in order to provide better surgical scheme for patients with coronary heart disease who received CABG.Methods 100 patients(56 males and 44 females)who underwent CABG in the Affiliated Hospital of Qingdao University from December 2017 to December 2019 were randomly selected.The included diagnostic criteria were:(1)three coronary artery lesions with stenosis ≥ 75%;(2)There was no contraindication of operation;(3)The number of bypass grafts was 4,and according to the preoperative coronary angiography,the target vessels were located in the left anterior descending system(anterior descending branch and diagonal branch),the left circumflex system(middle branch and blunt marginal branch),and the right coronal system(posterior descending branch or left ventricular posterior branch).Among them,50 patients only retained the main saphenous vein as the bridge vessel and anastomosed side to side with the first target vessel,which were recorded as the control group;The other 50 patients retained their branches during the acquisition of the great saphenous vein and anastomosed with the first target vessel end-to-side as a natural Y-shaped bridge,which was recorded as the observation group.The blood flow and Pi of the target vessels and corresponding anastomoses were recorded in both groups.According to the length of great saphenous vein and the length of excess vein removed during operation,the actual application length of vein was calculated.The left ventricular ejection fraction(LVEF),the incidence of cardiovascular adverse events and the healing of the incision of the great saphenous vein of the lower limbs were reviewed at 1 month,6 months and 1 year after operation.Results There was no significant difference in blood flow and PI between the two groups(P > 0.05).In the observation group,the blood flow of the diagonal or middle branch of the Y-shaped bridge end-to-side anastomosis of the natural branch of the great saphenous vein was significantly higher than that of the control group(P = 0.006),and its p I value was also better(P = 0.036).The blood flow(P = 0.037)and p I value(P = 0.026)of sequential blunt marginal branch in the observation group were also significantly better than those in the observation group.The postoperative echocardiography of the two groups was followed up,and the preoperative left ventricular ejection fraction showed that there was no significant difference between the two groups at 1 month and 6 months after operation(P >0.05);The improvement of left ventricular ejection fraction in the observation group 1 year after operation was significantly higher than that in the control group,and the difference was statistically significant(P = 0.002).There was no significant difference in the incidence of cardiovascular adverse events between the two groups(1 case in the observation group and 2 cases in the control group,P = 0.553)Conclusion this study compared the clinical effects of using natural Y-shaped saphenous vein bridge with traditional single sequential bridge.The results suggest that for the first target vessel(diagonal branch or middle branch)supplied by vein bridge,Y-shaped bridge has better blood flow and p I value,which may be related to its anastomosis mode.End to side anastomosis is better in hemodynamics than side to side anastomosis.Although the second target vessel is anastomosed side to side,the Y-shaped bridge structure does not have the first side to side anastomotic shunt,its sequential anastomotic pressure and flow are higher than the traditional single sequential,the bridge vessel has a smoother shape,and can provide better blood perfusion.The advantage of using natural Y-shaped bridge is also reflected in the recovery of postoperative cardiac function.The recovery of LVEF one year after operation is significantly better than that of traditional single sequential.Moreover,the total vessel length required for the application of Y-shaped vein is short.To sum up,in coronary artery bypass grafting,the branches of great saphenous vein found should be retained and actively used to construct Y-shaped bridge,which is of great significance to improve the patency rate of bridging vessels in the medium and long term,restore left ventricular function and reduce trauma.