Objective To compare the graft patency rates of conventional on-pump coronary artery bypass grafting （CCABG） and off-pump coronary artery bypass grafting （OPCAB） at 2 weeks，3 months and 1 year after surgery. Methods Clinical data of 200 patients who underwent coronary artery bypass grafting （CABG） in the First Affiliated Hospital of Harbin Medical University from May 2010 to November 2011 were retrospectively analyzed. All the 200 patients were divided into two groups according to different surgical procedures they received：CCABG group，61 patients including 32 male patients and 29 female patients with their age of 59.8±4.7 years；and OPCAB group，139 patients including 72 male patients and 67 female patients with their age of 59.6±8.9 years. Graft patency of all the patients was evaluated by 256-slice multislice computed tomography angiography （256-MSCTA） at 2 weeks，3 months and 1 year after CABG and compared between two groups. Results At 2 weeks，3 months and 1 year after CABG，the graft patency rates of left internal mammary artery （LIMA） grafting were not statistically different between CCABG group and OPCAB group，as well as those of great saphenous vein （GSV） grafting （P＞0.05）. The 1 year graft patency rates of LIMA grafting of CCABG group and OPCAB group were 92.31% and 91.94% respectively，and 1 year graft patency rates of GSV grafting of CCABG group and OPCAB group were 91.35% and 90.00% respectively. To compare the graft patency rates of different distal anastomotic locations，grafting to the left anterior descending （LAD） coronary artery had significantly higher patency rate than grafting to the right coronary artery （RCA，P＜0.05）. The 1 year graft patency rates of LAD grafting and RCA grafting were 97.78% and 85.90% respectively. But there was no statistical difference in graft patency rates at different respective distal anastomotic locations between OPCAB group and CCABG group （P＞0.05）. To compare early clinical outcomes of two groups，postoperative mechanical ventilation time，length of ICU stay，24-hour mediastinal drainage，24-hour blood transfusion，length of hospital stay，and hospitalization cost of OPCAB group were significantly shorter or lower than those of CCABG group （P＜0.05）. Conclusion Short-term graft patency rates of CCABG and OPCAB are quite similar. Patency rate of grafting to LAD is higher than that of grafting to RCA. OPCAB can produce better perioperative clinical outcomes than CCABG.
Coronary artery bypass grafting (CABG) is a major treatment method for coronary artery disease，but postoperative vein graft restenosis remains an unsolved problem. Research has confirmed that perioperative antiplatelet therapy can effectively reduce early coronary artery bypass graft thrombosis. Lipid-lowering therapy can significantly improve long-term patency of saphenous vein grafts after CABG. In addition，gene therapy provides a new direction to prevent vein graft restenosis after CABG.
Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.
Abstract： Objective To evaluate graft patency at one year after coronary artery bypass grafting （CABG） and analyze the risk factors of graft occlusion. Methods We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010. There were 37 males and 34 females with their average age of 59.8±7.7 years. All the patients underwent CABG performed by the same surgeon， and received standard drug therapy after surgery. At 1 year after CABG， 256-slice multislice computed tomography （MSCT） angiography was performed to evaluate graft patency. All the patients were divided into two groups according to their graft patency during follow-up， including 16 patients in the occluded graft group and 55 patients in patent graft group. Preoperative， intra-operative and postoperative variables were collected. Univiariate analysis and logistic regress analysis were performed to analyze risk factors of graft occlusion. Results The graft patency was 91.0% （172/189） at 1 year after CABG. Univiariate analysis showed that pre-operative cholesterol （t=-2.389，P=0.017）， diffused coronary artery disease （χ2=4.449，P=0.042）， diameter of target vessels （t=5.064，P=0.000）， non-adherence to prescribed antiplatelet medications （χ2=10.175，P=0.008） were potential risk factors of graft occlusion after CABG. Logistic regress analysis showed that diameter of target vessels ［RR=0.014，95% CI （0.001，0.229），P=0.003］ and non-adherence to prescribed antiplatelet medications ［RR=13.375，95% CI （1.075，175.536），P=0.044］ were significant risk factors for graft occlusion. Conclusion The graft patency is satisfactory at 1 year after CABG. Graft patency after CABG is closely related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.