Comparison Of Perioperative Effect Between Total Arterial Revascularization And Non-total Arterial Revascularization In Patients With Coronary Atherosclerotic Heart Disease

Objective: To compare the perioperative efficacy of modified total artery revascularizetion(LIMA+RA)and conventional non-total artery revascularization(LIMA+SVG,SVG)in patients undergoing coronary artery bypass grafting(CABG),and to evaluate whether there is a difference in the perioperative efficacy of modified total artery bypass grafting(LIMA+RA)and traditional bypass non-total artery bypass grafting(LIMA + SVG,SVG).Methods: The clinical data of patients who underwent CABG for coronary atherosclerotic heart disease(CAD)from January 2016 to September 2021 in the Department of Cardiovascular Surgery of our hospital were retrospectively collected.After screening,the perioperative data of patients with non-total revascularization(LIMA+SVG group,SVG alone group)who underwent modified total revascularization(LIMA+RA)and those who did not undergo modified total revascularization(LIMA+SVG group,SVG alone group)were statistically analyzed after 1:1 propensity score matching(PSM)to evaluate the perioperative safety and feasibility of modified total arterial revascularization Results: A total of 109 subjects who met the inclusion criteria were collected,including35 patients in the modified total arterial revascularization group(LIMA+RA)and 74 patients in the non-total arterial revascularization group(LIMA+SVG,SVG)by the traditional bypass surgery,including 64 patients in the LIMA + SVG group and 10 patients in the SVG group.After 1:1 PSM was performed in the modified LIMA+RA and LIMA+SVG group,a total of 27 pairs of fuzzy matches were obtained.After PSM,there was statistical significance in NYHY grade between the two groups(P< 0.05);after PSM,there was statistical significance in the number of bridging vessels(2 vessels/case)and intraoperative blood product transfusion volume between the two groups(P< 0.05);After 1:1 PSM in the modified LIMA+RA group and SVG group,a total of 7 pairs of fuzzy matching were obtained.After preoperative PSM,there was a statistically significant difference in the presence or absence of diabetes between the two groups(P< 0.05).After PSM,there was no significant difference in the number of bridging vessels,operation time,aortic cross-clamp time,CPB time,intraoperative blood loss and intraoperative blood product transfusion volume between the two groups(P> 0.05).There were no significant differences in mechanical ventilation time,postoperative ICU stay,postoperative aortic balloon pump IABP,postoperative extracorporeal membrane oxygenation(ECMO),postoperative continuous renal replacement therapy(CRRT),poor healing of the surgical area,stroke,gastrointestinal bleeding,and 28-day postoperative mortality after PSM between the modified LIMA+RA group and the LIMA+SVG and SVG groups,respectively.Conclusion: In this study,the data of patients with modified LIMA+RA revascularization used in our heart center were compared with the data of patients with traditional bypass surgery LIMA+SVG revascularization and SVG transplantation group in the perioperative period.After the preoperative,intraoperative and postoperative arterial bridge treatment was improved,the perioperative results of patients with modified LIMA+RA graft showed no increase in the occurrence of adverse events and no significant prolongation of hospital stay.For patients with diabetes and low LVEF(< 35%),no significant adverse events were observed in the perioperative period of patients with modified total arterial revascularization.Compared with the traditional bypass,the modified total arterial revascularization could reduce the occurrence of perioperative adverse events of total arterial revascularization.