ObjectiveTo explore the mid-term outcomes achieved by using the left internal mammary artery to saphenous vein composite grafts in off-pump coronary artery bypass surgery (OPCAB) for elderly patients. MethodsA total of 59 elderly patients (≥70 years old) underwent OPCAB by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) composite grafts in Xinhua Hospital between March 2006 and October 2012. There was 37 males and 22 females at age of 72.71±1.95 years. Twenty one patients used LIMA-SV composite grafts (LIMA-SV group), and 38 patients used LIMA-RA composite grafts (LIMA-RA group). ResultsAll patients successfully underwent OPCAB with LIMA-SV or LIMA-RA composite grafts. There was one early death in the LIMA-RA group. No statistical differences in early postoperative outcomes were found between the two groups (P > 0.05). During a follow-up of 12 to 91 months, no patient occurred revascularization. There were no statistical differences in overall survival or graft patency rate, and 1 year, 3 years or 5 years survival rates between the two groups (P > 0.05). The patency rate of LIMA in each group was 100% respectively. There was also no statistical difference in overall patency rate of SV and RA between the two groups at the end of 1 year, 3 years or 5 years (P > 0.05). ConclusionAlthough artery grafts are the best choice for OPCAB, LIMA-SV composite grafts can be used as an alternative graft for elderly patients whose RA or right internal mammary artery is not possible or advisable.
ObjectiveTo explore the outcomes achieved by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) Y-composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease. MethodsFrom January 2009 through May 2015, 56 patients (36 males and 20 females) with multiple vessel disease underwent MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts without cardiopulmonary bypass in our hospital. MIDCAB was performed through a left anterior minithoracotomy. Thirty four patients used LIMA-RA grafts, and twenty two patients used LIMA-SV grafts. ResultsAll patients success-fully underwent MIDCAB with LIMA-SV or LIMA-RA Y-composite grafts. No patient required to convert to sternotomy during the surgery. Revascularization was performed for 2 target vessels in 12 patients, 3 target vessels in 41 patients and 4 target vessels in 3 patients. Mean postoperative ventilation time was 27.14±31.35 h. Mean ICU time was 3.16±2.53 d, and mean postoperative inhosptial time was 11.89±3.91 d. Thirty-day mortality was 1.79% (1/56). At a follow-up of 1 to 77 months, no patients received revascularization. The overall survival at 2 years postoperatively was 94.4%±5.4% in the LIMA-RA group and 86.8%±9.2% in the LIMA-SV group (P=0.299). The patency rate of LIMA was 100.0%. The overall patency rate of RA or SV grafts at 2 years postoperatively was 90.3%±5.3% or 86.7%±6.3% with no statistical difference (P=0.265). ConclusionMIDCAB with LIMA-RA or LIMA-SV Y-composite grafts is a safe and an effective procedure with favorable early and mid-term outcomes for patients with multiple vessel disease. LIMA-SV composite graft can be used as an alternative graft for patient whose RA is not possible or advisable.