scholarly journals No-touch Harvesting in Off-pump Coronary Artery Bypass Grafting With Sequential Saphenous Vein Graft: A Single-center Prospective Randomized Controlled Trial

2020 ◽  
Author(s):  
Xuejian Hou ◽  
Kui Zhang ◽  
Taoshuai Liu ◽  
Yang Li ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Abstract Background: Coronary artery bypass grafting (CABG) materials comprise the combination of the left internal mammary artery and saphenous vein. The patency rate of vein grafts is considered not ideal; more studies support that the no-touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the NT technology is used in the sequential saphenous vein grafting during off-pump coronary artery bypass surgery. This study explored whether the NT technique is safety and efficacy compared to the conventional manner in the off-pump coronary artery bypass surgery using sequential vein graft.Methods: This was a prospective single-center randomized controlled clinical trial. A total of 200 patients undergoing off-pump coronary artery bypass grafting in the sequential saphenous graft were randomly assigned to two groups: The no-touch(NT) and the conventional (CON) groups. Perioperative and postoperative data were collected prospectively during the hospital stay. The occlusion of sequential grafts was measured by cardiac computed tomography angiography (CCTA) 3-months post CABG. Leg wound complications were followed up. The mean diameter of sequential grafts for the first 100 patients was measured using CCTA, 3-months after the operation.Results: The primary endpoint was that there was no difference in occlusion of sequential venous grafts between the two groups (NT: 9/180 (4.4%), CON: 5/194 (1.5%), p=0.22). Similarly, there were no differences in composite clinical events (NT: 2/91 (2.2%), CON: 1/96 (1.0%), p=0.96). There was no difference in the leg wound complications between the two groups (NT: 8/91 (8.8%), CON: 4/96 (4.2%), p=0.20). However, there was a significant difference in the average diameter of sequential grafts between the two groups (NT: (2.98±0.42), CON: (3.26±0.51), p=0.005).Conclusions: The early clinical results suggest that the NT technique is safety and efficacy compared to the conventional technique in sequential grafting in off-pump coronary artery bypass surgery. The sequential grafts early expansion in the NT technique is not as pronounced as the conventional technique, which may have a long-term protective effect on the grafts.Trial Registration: Registered 1 November 2018, ClinicalTrials.gov NCT03729531, http://www.clinicaltrials.gov

A New Multisuction Cardiac Positioner for Multivessel Off-Pump Coronary Artery Bypass Grafting

2006 ◽  
Vol 1 (3) ◽  
pp. 126-130 ◽  
Author(s):  
Hirokuni Arai ◽  
Tomohiro Mizuno ◽  
Tomoya Yoshizaki ◽  
Fusahiko Itoh ◽  
Keiji Oi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Objective To accomplish successful multivessel off-pump coronary artery bypass grafting, safe, reproducible, and effective exposure of all coronary territories is essential. For this purpose, we developed a new, simple, multisuction cardiac positioner. Methods This new cardiac positioner consists of 3 small independent suction cups and suction tubes made of silicone. Unlike an apical suction cardiac positioner, this positioner has no arm. The suction cups can be applied with negative pressure of 300 mm Hg to various surfaces of the ventricle, including not only the apex but also the lateral, inferior, and right ventricular walls, according to surgeon preference. We applied this positioner in 15 clinical multivessel off-pump coronary artery bypass procedures. Results In all cases, all target vessels including those on the lateral or inferior wall were successfully exposed and grafted without hemodynamic compromise. Surgical exposure, especially on the lateral and inferior walls, was quite similar to that of conventional coronary artery bypass graft procedures performed during cardiopulmonary bypass. Conclusions The multisuction cardiac positioner provided reproducible and easy access in multivessel off-pump coronary artery bypass surgery. This simple, variable, and inexpensive cardiac positioner may be used as a new tool to aid in the performance of successful multivessel off-pump coronary artery bypass surgery.

Nicorandil Infusion during Off-Pump Coronary Artery Bypass Grafting Reduces Incidence of Intra-aortic Balloon Pump Insertion

2016 ◽  
Vol 11 (2) ◽  
pp. 123-127 ◽  
Author(s):  
Kamales Kumar Saha ◽  
Ajay Kumar ◽  
Mandar Manohar Deval ◽  
Kakalee K. Saha ◽  
Rinu V. Jacob ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Intra Aortic Balloon Pump ◽  
Pump Coronary Artery Bypass

Objective Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion. Methods Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion). Results A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206). Conclusions Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.

scholarly journals No-Touch Harvesting in Off-Pump Coronary Artery Bypass Grafting With Sequential Saphenous Vein Grafting: A Single-Centre Prospective Randomized Controlled Trial

2021 ◽  
Author(s):  
Xuejian Hou ◽  
Kui Zhang ◽  
Taoshuai Liu ◽  
Yang Li ◽  
Yang Zhao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Conventional Technique ◽  
Off Pump ◽  
Vein Grafts ◽  
Pump Coronary Artery Bypass

Abstract Background: The main graft material for coronary artery bypass grafting (CABG) is the combination of the internal mammary artery and great saphenous vein. The patency rate of vein grafts is considered not ideal; more studies support that the no-touch (NT) procedure can improve the patency rate of vein grafts. However, it is not clear that the NT technology is used in the sequential saphenous vein grafting during off-pump coronary artery bypass surgery. This study explored whether the NT technique is as safe and effective as the conventional technique in off-pump coronary artery bypass surgery using sequential vein grafts.Methods: This was a prospective single-centre randomized controlled clinical trial. A total of 200 patients undergoing off-pump coronary artery bypass grafting in the sequential saphenous graft were randomly assigned to two groups: the no-touch (NT) and conventional (CON) groups. Perioperative and postoperative data were collected during the hospital stay. The occlusion of sequential grafts was measured by cardiac computed tomography angiography (CCTA) 3 months post CABG. Leg wound complications were followed up. The mean diameter of sequential grafts for the first 100 patients was measured using CCTA 3 months after the operation.Results: The primary endpoint was that there was no difference in occlusion of sequential venous grafts between the two groups (NT: 9/180 (4.4%), CON: 5/194 (1.5%), p=0.22). Similarly, there were no differences in composite clinical events (NT: 2/91 (2.2%), CON: 1/96 (1.0%), p=0.96). There was no difference in leg wound complications between the two groups (NT: 8/91 (8.8%), CON: 4/96 (4.2%), p=0.20). However, there was a significant difference in the average diameter of sequential grafts between the two groups (NT: (2.98±0.42), CON: (3.26±0.51), p=0.005).Conclusions: The early clinical results suggest that the NT technique is as safe and effective as the conventional technique in sequential grafting in off-pump coronary artery bypass surgery. The sequential graft early expansion in the NT technique is not as pronounced as that in the conventional technique, which may have a long-term protective effect on the grafts.Trial Registration: Registered 1 November 2018, ClinicalTrials.gov NCT03729531, http://www.clinicaltrials.gov

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