复合桥血管在冠状动脉病变合并升主动脉严重钙化小切口冠状动脉旁路移植术中的应用及对中期通畅率的影响

目的探讨Y型复合桥血管(左胸廓内动脉-桡动脉、左胸廓内动脉-大隐静脉)在左前外侧小切口冠状动脉旁路移植术(MIDCAB)中的应用以及术后中期通畅率。方法回顾性分析2013年1月至2015年5月38例冠状动脉病变合并升主动脉严重钙化患者应用Y型复合桥血管的MIDCAB临床资料。男29例、女9例,年龄56~83〔平均(67.8±8.2)〕岁,通过冠状动脉血管造影(CTA)评估术后1年桥血管通畅率。结果全例均顺利完成MIDCAB,无术中转正中开胸,平均手术时间为(3.6±1.1)h,24例采用左胸廓内动脉-桡动脉Y型复合桥血管,14例采用左胸廓内动脉-大隐静脉Y型复合桥血管,平均吻合移植血管(2.7±0.5)支。无围术期二次开胸止血、无术后脑卒中发生以及围术期心梗发生,围术期新发心房颤动3例,经对症治疗恢复窦性心律;肾衰竭1例,经血液透析治愈;ICU入住时间(52.8±19.2)h,全组无住院死亡。术后1年通过冠状动脉CTA随访显示,桥血管的总通畅率为97.1%,其中全部患者左胸廓内动脉-左前降支吻合口通畅率为100%,左胸廓内动脉-桡动脉组出现桡动脉桥血管线征1例,左胸廓内动脉-大隐静脉桥血管阻塞1例,累积桥血管通畅率:左胸廓内动脉-桡动脉桥血管与靶血管吻合通畅率为95.8%,左胸廓内动脉-大隐静脉与靶血管吻合通畅率为92.8%(P>0.05)。结论对于冠心病合并升主动脉严重钙化患者而言,MIDCAB术中采用Y型复合桥血管安全、有效,中期通畅率良好。全动脉桥血管(左胸廓内动脉-桡动脉)是最佳方案,但对于桡动脉无法使用或获取后可能发生手部缺血等并发症的患者,左胸廓内动脉-大隐静脉复合桥血管仍是一种良好的选择。     

冠状动脉旁路移植术后近中期桥血管闭塞的相关高危因素分析

目的 分析冠状动脉旁路移植术（coronary artery bypass graft,CABG）后近中期桥血管的通畅率及其相关的危险因素,为术后患者预防桥血管病变提供依据。方法 选取2009年9月至2014年9月在衡水市人民医院心外科接受首次CABG术患者38例,入选的患者在复查期间未再行任何血管再通术（PTCA、PCI及CABG等）,术后4～59（28.1±17.6）个月复查时均行CTA检查,部分患者行CAG检查对照,分别计算动脉桥血管和静脉桥血管的通畅情况,分析影响CABG术后患者桥血管通畅情况的高危因素。结果 CABG术后桥血管的总体通畅率为75.3%;LIMA的总体通畅率为92.9%,SV的总体通畅率为64.4%。结论 乳内动脉桥血管通畅率明显高于大隐静脉桥血管;患者的手术年龄、性别以及综合相关危险因素等都会影响桥血管通畅率。     

冠脉搭桥传统术式和Y-graft术式的桥血管流量对比

目的分析传统术式和在左乳内动脉(left internal mammary artery, LIMA)上以Y型桥方式行冠状动脉旁路移植术(coronary artery bypass grafting, CABG)的术中桥血管流量情况。方法选择2019年2月至2020年3月25例行上述两种方式之一搭桥的患者,根据非LIMA移植血管近端吻合口位置,分为传统术式组(桥血管近端吻合于主动脉,n=18)和LIMA Y-graft组(桥血管近端吻合于LIMA,n=7),使用MEDISTIM VeriQ血流仪于术中行桥血管流量实时测定,比较平均血流量(mean graft flow, MGF)和搏动指数(pulsatility index, PI)。结果传统术式组和Y-graft组患者LIMA-LAD桥MGF分别为26(17)ml/min和24(31)ml/min,平均PI分别为2.02±0.90和3.68±2.19,差异均无统计学意义(P0.05);传统术式组和Y-graft组患者非LIMA桥MGF分别为32(21.25)ml/min和27(26)ml/min,PI分别为2.57±1.17和2.89±1.70,差异也无统计学意义(P0.05)。结论传统术式与LIMA Y-graft吻合的桥血管的血流动力学效果一致,术者可结合临床选择合适手术方案。     

冠状动脉旁路移植术后桥血管造影特点分析

目的总结冠状动脉旁路移植术(CABG)后桥血管造影特点,分析相关因素对桥血管通畅率的影响。方法选择2004年4月至2006年4月我院CABG术后因心绞痛复发再入院行冠状动脉造影(CAG)的256例患者,男性218例,平均年龄(61.2±9.7)岁。CABG到复查CAG的间隔时间(50.9±40.1)个月。共722支桥血管,其中左乳内动脉(LIMA)桥215支,大隐静脉(SV)桥485支,左桡动脉(RA)桥19支,右乳内动脉(RIMA)桥3支。桥血管造影完全闭塞或狭窄≥75%视为桥血管病变。结果31.6%(228/722)的桥血管发生病变。LIMA桥病变率13.5%(29/215),SV桥病变率39.2%(190/485),RA桥病变率42.1%(8/19),RIMA桥病变率33.3(%1/3)。术后1年内LIMA桥和SV桥病变率分别达14.6%和32.9%,之后随时间缓慢增加。不同靶血管的SV桥通畅率有明显差别。手术年龄<50岁者桥血管病变率增加。性别、序贯吻合及综合危险因素对桥血管通畅率无明显影响。结论CABG术后桥血管病变较常见,是造成术后心绞痛复发的重要原因。LIMA桥的通畅率明显优于SV桥。不同桥血管、不同靶血管、手术年龄均明显影响桥血管通畅率。     

左胸小切口与胸骨正中切口非体外冠状动脉旁路移植术中左乳内动脉桥血流对比分析

目的:通过超声瞬间血流仪在术中评估左胸小切口冠状动脉旁路移植术(MIDCAB)和胸骨正中切口非体外循环下冠状动脉旁路移植术(OPCAB)患者左乳内动脉(LIMA)桥的血流情况。方法:2013-01至2015-07期间300例患者接受OPCAB,LIMA全部与左前降支(LAD)吻合。70例患者采用MIDCAB,为MIDCAB组,同期有230例患者采用传统正中开胸OPCAB,为传统OPCAB组。术中应用即时血流测量技术对旁路血管进行血流测量。对比分析两组术前、术后的各项指标及LIMA桥血管的平均流量、搏动指数、舒张期充盈百分比和血流波形。结果:传统OPCAB组和MIDCAB组的手术输血量分别为(3.00±5.42)U和(1.06±2.17)U;术后心肌肌钙蛋白I(c Tn I)峰值分别是(2.84±9.93)ng/ml和(0.69±1.74)ng/ml;呼吸机使用时间分别是(27.90±66.90)h和(14.20±20.80)h;重症监护病房停留时间分别是(64.10±89.60)h和(35.20±39.20)h,两组差异均有统计学意义(P0.05)。两组的LIMA至LAD的桥血管平均流量[(29.45±18.19)ml/min vs(29.04±15.85)ml/min]、搏动指数(2.68±1.19 vs 2.44±0.84)、舒张期充盈百分比[(71.47±11.12)%vs(70.25±11.30)%]的差异均无统计学意义(P均0.05)。结论:进行LIMA至LAD搭桥,采用MIDCAB可取得与传统OPCABG同样的效果,术后早期吻合口质量可靠。     

即时血流测量技术在冠状动脉旁路移植术中的应用

目的应用即时血流测量技术术中评估冠状动脉桥的通畅性.方法对80例行冠状动脉旁路移植术患者(共186根桥)术中应用即时血流测量技术进行流量测量,将血流量及血流波形存储在即时血流测量仪中进行分析.同时记录每根桥远端血管情况,冠状动脉病变弥漫程度,围手术期状况以及心电图变化.结果80例中67根应用乳内动脉进行前降支旁路移植,平均流量25.0±18.0ml/min,应用大隐静脉旁路移植119根,其中对角支22根,平均血流量36.8±18.6ml/min,钝缘支38根,平均血流量40.3±25.0ml/min.右冠状动脉50根,平均血流量38.0±14.7ml/min,后降支9根,平均血流量25.5±14.7ml/min.平均搏动指数2.76±1.57.远端血管细,且病变弥漫的冠状动脉血管平均血流量低.通畅的乳内动脉血流为舒张期灌注血流,通畅的静脉桥血流为收缩、舒张期双重灌注血流,舒张期灌注血流为主.2根桥(2/188,1.1%)由于血流量及血流波形不满意,拆除后进行了再次旁路移植,血流量及血流波形改善.结论即时血流测量技术是一种简单、易行的判断冠状动脉桥通畅性的方法.血流波形及搏动指数是判断桥通畅的重要指标.     

冠状动脉旁路移植术后静脉桥血管通畅率的研究进展

<正>冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是现今治疗冠心病最有效的手术方法之一[1],术后5~10年内约25%~50%的桥血管会发生再狭窄或者闭塞[2],评价CABG疗效的最主要指标之一是桥血管近、远期的通畅率。国内外CABG采用最多的移植血管是乳内动脉(internal mammary artery,IMA)和大隐静脉(saphenous vein,SV)。由于IMA长度受限以及冠心病患者大多为多支冠状动脉病变,所以自体SV仍然是CABG术中最常用的桥血管移植材料[3]。如何提高静脉桥血管的远期通畅率已经成为CABG术后的一个研究热点。本文对近年来有关静脉桥血     

体外循环与非体外循环冠状动脉旁路移植术后移植血管通畅率比较

目的比较体外循环冠状动脉旁路移植术(CCABG)与非体外循环冠状动脉旁路移植患者术(OPCAB)术后移植血管通畅率。方法选取2007年8月—2012年8月我院收治的行冠状动脉旁路移植术患者372例,按照手术方式不同将其分为CCABG组176例和OPCAB组196例,比较两组移植血管数量、手术时间、呼吸机辅助时间、24 h引流量及输血量、肾功能不全发生率、神经系统并发症、肺部并发症、住院时间等,以及移植血管通畅率。结果 CCABG组呼吸机辅助时间长于OPCAB组,住院时间短于OPCAB组,术后引流量、术后输血量均大于OPCAB组,肾功能不全发生率、神经系统并发症、肺部并发症发生率均高于OPCAB组(P0.05)。术后2周、3个月以及1年,两组移植血管〔包括左乳内动脉(LIMA)和大隐静脉(GSV)〕通畅率比较,差异无统计学意义(P0.05)。结论CCABG和OPCAB术后移植血管通畅率差异不明显,应根据患者具体情况选择适合的方式。     

经右侧桡动脉入径行选择性左乳内动脉造影5例体会

<正>1背景由于与静脉移植桥相比,左乳内动脉(left internal mammary artery,LIMA)具有显著优越的远期通畅率,被广泛用作旁路移植物[1]。因此,在诊断性冠状动脉造影检查后,当患者被判断为适合行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)时,应进行LIMA的术前评估,以确保在用作旁路移植物之前通畅。另一方面,对于使用LIMA作为桥血管的CABG术后患者,如再次评价桥血管通畅情况时,也需要行LIMA造影检查。LIMA桥血管造影检查和介入治疗的经典入路为股动脉入径,近年来采用左侧桡动脉入径造影有所增加[2]。越来越多的证据支持经桡动脉入径进行介入治疗可改善患者预后,提高医     

心脏不停跳冠状动脉旁路移植术的中期随访分析

目的探讨心脏不停跳冠状动脉旁路移植术(OPCAB)的围手术期特点及中期随访结果分析。方法回顾性总结从1998年11月至2008年12月期间,我科实施的单纯冠状动脉旁路移植术患者的围术期资料,包括心脏停跳下冠状动脉旁路移植术(CCAB)92例和OPCAB 151例,比较分析了术前常见的危险因素和围手术期临床资料,并对术后7年中期随访情况进行比较分析。结果术前危险因素中,除年龄和糖尿病外其余在两组之间无明显差别。OPCAB组与CCAB组比较,平均远端血管吻合口数明显减少(3.08±0.76比3.34±0.76,P=0.025),手术时间、术后机械通气时间、术后ICU时间和术后住院天数则显著缩短,术后主要并发症(如低心排出量、IABP使用、肾功能不全)明显减少,住院死亡率无明显差别。术后中期随访结果显示OPCAB组射血分数显著比CCAB组高(63.1%±11.7%比59.0%±10.8%,P=0.049),OPCAB组血管桥闭塞率也明显高于CCAB组(44.7%比18.8%,P=0.022)。结论 OPCAB在术后恢复和术后主要并发症减少方面均明显优于CCAB。从术后中期的随访来看,OPCAB组射血分数显著高于CCAB组,显示OPCAB在心功能恢复方面优于CCAB。术后7年OPCAB组血管桥闭塞率显著高于CCAB组,说明OPCAB操作难度大,可能影响了血管桥的中期通畅率。     

微创经左胸小切口非体外循环单支、多支冠状动脉旁路移植术33例

目的 探讨左侧肋间小切口非体外循环单支、多支冠状动脉旁路移植术的安全性和可行性。方法 回顾性分析2014年5月~2019年10月左胸前外侧小切口非体外循环下冠状动脉旁路移植术33例资料。单支病变17例,多支病变16例。左胸前外侧小切口6cm-10cm,直视下获取左乳内动脉(LIMA),完成LIMA-左前降支(LAD)吻合,升主动脉（Ao）-大隐静脉(SVG)序贯-对角支(D)或中间支（ICA）-钝缘支(OM)-后降支(PDA)或左室后支(PLV)共2~4支旁路移植血管吻合。结果 全组LIMA-LAD桥32例,Ao-SVG-LAD 1例。Ao-SVG-D 2例,Ao-SVG-OM 2例、Ao-SVG-OM-PDA 2例,Ao-SVG-ICA-PDA 3例,Ao-SVG-D-OM-PDA 4例,Ao-SVG-D-OM-PLV 3例。33例手术均顺利完成,围术期无死亡、心肌梗死、脑卒中、呼吸衰竭、肾功能衰竭、切口感染等并发症。术后呼吸机时间7h~18 h(9.14±3.82)h;ICU时间6h~20 h（12±8）h。术后住院5d~11d(8±3)d。出院时复查冠状动脉CT,33例均提示左乳内动脉桥、大隐静脉序贯桥通畅性良好。随访3个月~3年,平均8个月,无死亡、心绞痛和心肌梗死。30例复查冠状动脉, LIMA桥、SVG序贯桥通畅性良好。结论 左侧肋间小切口非体外循环下多支冠状动脉旁路移植术安全可行。     

Outcomes of left internal mammary artery with saphenous vein composite graft to bypass the left anterior descending artery: a propensity-matched study

BackgroundThis study aimed to evaluate the early and mid-term outcomes of a novel strategy of using the in-situ left internal mammary artery (LIMA) with the great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG).MethodsA total of 979 patients took part in this retrospective observational study; 83 patients were propensity-score matched to the LIMA + SVG group and 83 to the LIMA − LAD group. Early mortality, postoperative complications, mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared among the two matched groups after the procedure.ResultsNo significant differences in early mortality and postoperative complications rates were detected between the two matched groups. For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but there was no significant statistical difference (14.9% vs. 12.8%, hazard ratio =1.20, 95% CI, 0.24 to 7.95; P=0.70) between the matched groups. Computed tomography coronary artery angiography (CTCA) images showed a LIMA + SVG composite graft patency rate of 94% (32/34) 25 months after the procedure.ConclusionsUsing the in situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes. These findings may provide an alternative emergency strategy when in situ LIMA cannot bypass LAD. Further study needs to be conducted to test longer-term outcomes.     

Atresia of the left internal mammary artery graft following percutaneous intervention of the left main

Because of its durability and patency, the left internal mammary artery (LIMA) is preferentially used to bypass obstructive lesions in the left main coronary artery (LMCA) and/or the left anterior descending coronary artery (LAD). The long-term patency of the LIMA graft is determined by several factors, principal among them being the dynamic competition between flow through the internal mammary artery graft and the LAD. We report a patient with LMCA stenosis and a well-functioning and mature LIMA graft, who after percutaneous intervention of the LMCA and normalized antegrade flow in the LAD, developed atresia of a large caliber LIMA graft.     

Individual Versus Sequential Saphenous Vein Grafts for on-Pump Coronary Artery Bypass Grafting – Does Smaller Coronaries in Indians Affect Graft Choice? – A Mid-Term Patency Comparison Study

PurposeAlthough multiarterial grafting or bilateral mammary artery use is being increasingly emphasized for contemporary coronary artery bypass grafting (CABG) practice, saphenous vein graft (SVG) still accounts for 80% of all CABG conduits (Park et al., 2020) [1]. In India, both the individual and sequential saphenous grafting techniques are used arbitrarily, and there has not been a study that compares the mid-term patency of these two. This is specially relevant in view of smaller coronaries in Indians than the Caucasian counterparts. This study aims to compare the patency for on pump CABG’s.MethodsIn the present study, 323 patients underwent either sequential (group A, N = 151 grafts, each graft having two anastomoses each) or individual (group B, N = 344 grafts) saphenous vein CABG, between February 2014 and June 2017. The SVG anastomoses were created on obtuse marginal (OM1/OM2) and posterior descending artery (PDA). The graft patency of the vein grafts as well as the left internal mammary artery were assessed by serial coronary angiograms.ResultsResults were evaluated at 6 months, 1, 2 and 3 years post operatively. Group A showed a higher graft patency at 3 years at 80.8%, and group B, 67.1% (P = 0.002). Also, anastomoses on sequential conduits had overall better patency rates at three years (77.2% vs 67.2%, P = 0.005). The groups showed similar results at one year post operatively.ConclusionsSequential bypass grafts were associated with superior mid-term patency compared with individual grafts. These findings suggest the more favourable results of sequential bypass grafting to be attributed to the enhanced flow haemodynamics.     

Sequential radial artery grafting three-vessel coronary artery disease

Our objective was to compare the results of revascularization by sequential radial artery (RA) grafting with a left anterior descending left internal mammary artery (LIMA)-RA t-composite grafting technique. Patients were grouped as those with proximal anastomoses performed on the ascending aorta (Group A; n = 38), and those with proximal anastomoses performed on the LIMA as t-grafts (Group T; n = 13). Neither of the two groups revealed any mortality. The average number of grafts was lower in Group T (2.23 +/- 0.43 in group T and 2.85 +/- 0.69 in group A, p < 0.05). The results of the control coronary artery angiographies were superior in Group A. The patency rate of the RA grafts was 96.8% in Group A. Of the 20 distal anastomoses performed with RA grafts in 8 patients from Group T, nine (45%) were found to be patent. The patency rates of RA grafts with sequential distal anastomoses were found to be better when the proximal anastomosis was performed on the ascending aorta rather than on the LIMA. In conclusion, sequential distal anastomosis of RA grafts seem to be safe and effective when proximal anastomoses are performed on the ascending aorta.     

非体外循环冠状动脉旁路移植术185例临床报告

目的 总结非体外循环冠状动脉旁路移植术（off pump coronary artery bypass grafting，OPCAB）185例临床经验。方法 185例病人接受OPCAB，采用左乳内动脉旁路者160例，且均与前降支吻合，其余旁路采用大隐静脉，术中采用超声血流检测仪测量旁路血管旁路的血流量、旁路血流的灌注指数（perfusion index，PI）及其波形，判断旁路通畅情况。结果 本组死亡1例，其余病人恢复顺利，心绞痛症状消失，心功能（纽约心脏协会分级）恢复至Ⅰ～Ⅱ级。结论 OPCAB是一种合理、安全的术式，临床效果满意。     

Comparative study of the postoperative flow in the saphenous vein and internal mammary artery bypass grafts.

Postoperative coronary bypass flow was evaluated in two groups of randomly selected patients with grafts to the left anterior descending artery (LAD). Saphenous vein bypass grafts were placed in 27 patients and internal mammary artery grafts in 25 patients. Postoperative flow studies were performed in both groups with roentgendensitometric methods based on the transit time of radiopaque media along the graft plus the mean graft diameter. There was no significant difference between the two groups of patients for age, duration of symptoms, or the frequency of hypertension, diabetes mellitus, prior myocardial infarction, or cardiomegaly. Intraoperative bypass flows were 75+/-27 and 77+/-24 ml. per minute for the saphenous vein group (SVG) and internal mammary artery group (IMAG), respectively. There was no significant difference in the heart rate or mean aortic pressure at the time of the roentgendensitometric flow study. The mean graft diameters were 3.0+/-0.5 and 1.9+/-0.3 mm. for the SVG and IMAG, respectively (p less than 0.001). The ratios of graft diameter to LAD diameter were 1.9+/-0.3 and 1.2+/-0.2 for the SVG and IMAG, respectively (p less than 0.001). The roentgendensitometric postoperative flows were 68+/-27 ml. per minute in the SVG and 46+/-16 ml. per minute in the IMAG (p less than 0.01). The present study indicates that flow in significantly higher in saphenous vein than in internal mammary artery bypasses and that the difference in flow may in part be explained on the basis of the graft diameter.     

Total Arterial Myocardial Revascularization Using New Composite Graft Techniques for Internal Mammary and/or Radial Arteries Conduits

Abstract Background: Total arterial myocardial revascularization (TAMR) is feasible because of the excellent long-term patency of the arterial conduits. We present five new surgical configurations for TAMR. Methods: Between December 1998 and July 1999,34 patients with triple vessel disease underwent TAMR. All patients were in CCS 111 or IV. Sketelonized internal mammary arteries (IMAs) were used. The surgical techniques for TAMR consisted of Y or T composite grafts constructed between the in situ RlMA and free LIMA graft or radial artery (RA) conduit in three different configurations. Other techniques uses included a T graft constructed between the RA conduit and free LIMA graft in two configurations. Twenty-six (76%) patients underwent contrast-enhanced TTE color Doppler before and a after adenosine provocative test, and seven (20%) patients had postoperative coronary angiography. Results: Overall, 144 anastomoses (average number per patient, 4.2) were completed. One (2.9%) patient undergoing an inverted T graft technique died on postoperative day 2. Another patient (2.9%) undergoing the right Y graft technique using IMAs and RA suffered pe-rioperative AM1 due to RA conduit vasospasm. Contrast-enhanced TTE color Doppler before and after the adenosine provocative test and at 1 week postoperation revealed a coronary flow reserve (CFR) of 2.1 ± 0.2 in the LIMA stem, and in the RlMA stem, a CFR of 2.3 ± 0.3 (P < 0.007). In one patient undergoing the right Y graft technique using IMAs, we found only anomalous flow dynamic parameters of RIMA, suggesting a partial graft closure. The angio-graphic examination revealed a free LIMA graft closure. At 6 ± 2.4 months after operation 33 patients were alive and free of angina. The IMAs stem evaluation by TTE color Doppler at follow-up revealed a 2.45 ± 0.1 mm LIMA diameter and 2.6 ± 0.2 mm RlMA diameter, which was more than early postoperative data of P < 0.001 and P < 0.007, respectively. Conclusion: These data indicate that TAMR in young patients perhaps offers a better postoperative outcome and perhaps should be part of the surgical armamentarium. These techniques apply the “nontouch” principle and should be taken into consideration in patients with a heavily calcified aorta. Contrast-enhanced TTE color Doppler is a safe, accurate, and noninvasive test, which allows assessment of IMA patency and CFR evaluation. The flow reserve of the IMAs seems to be adequate for multiple coronary anastomoses.     

Intraoperative Flu?messung koronarer Bypassgef??e mit der Ultraschall-Transit-Zeit-Methode

The aim of the study was to compare the mean and maximum flow and the flow pattern of coronary vein grafts (SVG) supplying target vessels of the inferior and lateral wall with internal mammary (IMA) grafts to the left anterior descending artery (LAD). In 21 patients 25 bypass grafts (13/25 SVG, 12/25 IMA) were investigated. Using the transit time ultrasound method, flow was measured every 5 ms and the flow data of 60 s were acquired. The flow pattern showed significant differences between both graft types during their cycle. IMA grafts showed only one peak occurring after 22.1+/-12.3% and the second after 63.4+/-15.5% of their cycle. The mean flow was not different in both graft types (IMA: 45.3+/-27.0 ml/min and SVG: 41.8+/-26.7 ml/min, p = n. s.) as it was the case for the maximum flow (IMS: 98. 4+/-45.2 ml/min and SVG: 75.7+/-55.4 ml/min, p = n. s.). In conclusion, there is a different flow pattern for both graft types concerning the number and the occurrence of flow-peaks in the bypass cycle. The mean and peak flow showed no significant difference.     

Aspirin plus ticagrelor or clopidogrel on graft patency one year after coronary bypass grafting: a single-center,randomized, controlled trial

BackgroundDual antiplatelet therapy (DAPT) improves early post-operative graft patency, but the optimal DAPT strategy for the patients after coronary artery bypass grafting (CABG) has not been confirmed. We sought to evaluate the effect of aspirin plus ticagrelor versus aspirin plus clopidogrel on saphenous vein graft (SVG) patency within 1 year after CABG.MethodsBetween October 2017 and December 2018, 147 consecutive patients undergoing elective CABG at Changhai Hospital were randomized into two groups: group AT, receiving aspirin 100 mg/d plus ticagrelor 2×90 mg/d; group AC, receiving aspirin 100 mg/d plus clopidogrel 75 mg/d. Both DAPTs should be administered within 24 h when clinical stability was ensured. 64-multislice computed tomography angiography (MSCTA) was used to assess the graft patency at 12 months after CABG.CYP2C19 gene variants were measured to assess the clopidogrel efficacy on graft patency.ResultsAmong the 147 participants who completed the study, one (0.7%) patient from the AC group died at 5 weeks after surgery due to severe infection. All other patients were treated with DAPT for 12 months and underwent 64-MSCTA according to schedule. There were no significant differences in pre-operative characteristics and intraoperative transit-time flow measurement findings between the two groups. Besides, no significant differences in the incidence of major adverse cardiac events (MACEs) and major bleeding were observed. A 64-MSCTA showed that SVG patency was 91.0% (141 of 155) in the AT group and 89.9% (161 of 179) in the AC group (P=0.751). No significant associations were found between different CYP2C19 genotypes and SVG patency (P>0.05).ConclusionsEither aspirin plus ticagrelor or aspirin plus clopidogrel can maintain a fairly high graft patency rate in the early phase after CABG, regardless of CYP2C19 genotypes.