Single versus sequential saphenous vein grafting of the circumflex system: A flowmetric study

Figures & data

Figure 1.  Perioperative troponin I leakage (1A) and follow-up freedom from treatment failure (1B) between the two groups.

Table I.  Demographic data.

	Group A (sSV-CABG) 45 patients	Group B (seqSV-CABG) 45 patients	p
Age (years)	78.6±4.2	76.7±3.9	0.451
Male Sex	42 (93.3%)	41 (91.1%)	0.694
Euroscore (mean±S.D.)	5.2±1.9	5.4±2.2	0.509
Diabetes	36 (80.0%)	39 (86.6%)	0.245
Hypertension	31 (68.8%)	33 (73.3%)	0.141
Current Smoke	15 (33.3%)	12 (26.6%)	0.207
Dyslipidemia	17 (37.8%)	19 (42.2%)	0.413
COPD	39 (86.6%)	37 (82.2%)	0.764
AMI ≤ 4 weeks	11 (24.4%)	14 (31.1%)	0.352
Left Main Stem Disease	18 (40.0%)	15 (33.3%)	0.512
Preoperative IABP	28 (62.2%)	25 (55.5%)	0.667
Acute coronary syndrome	15 (33.3%)	16 (35.5%)	0.660
Preoperative E.F.<30%	28 (62.2%)	25 (55.5%)	0.667
Preoperative E.F.31%-49%	16 (35.5%)	18 (40.0%)	0.664
Preoperative E.F.>50%	1 (2.3%)	2 (4.5%)	0.557
LAD TIMI score (mean±S.D.)	1.03±0.48	1.12±0.51	0.092
CX TIMI score (mean±S.D.)	1.56±0.38	1.39±0.49	0.601
RX TIMI score (mean±S.D.)	0.99±0.32	0.95±0.74	0.259
Pre-op. WMSI (mean±S.D.)	1.68±0.46	1.73±0.31	0.183

AMI: acute myocardial infarction; IABP: intraaortic balloon pump; COPD: chronic obstructive pulmonary disease; E.F.: left ventricular ejection fraction; LAD: left anterior descending; CX: circumflex artery; RX: right coronary artery; WMSI: wall motion score index.

Table II.  Intraoperative data.

	Group A (sSV-CABG) 45 patients	Group B (seqSV-CABG) 45 patients	p
ACC time (minutes)	37.0±16.2	46.9±19.8	0.055
CPB time (minutes)	76.1±39.7	82.6±24.5	0.198
N° anastomoses/pt	3.09±0.39	3.98±0.85	0.042
LIMA	45 (100.0%)	44 (97.7%)	0.500
RA	11 (24.4%)	9 (20.0%)	0.612
Complete revascularization	45 (100.0%)	45 (100.0%)	–
LIMA mean flow	48.2±19.6 ml/min	46.7 ±26.3 ml/min	0.185
LIMA P.I.	1.2±0.4	1.0±0.7	0.389
RA-to-RX mean flow	52.2±10.7 ml/min	50.8±12.9 ml/min	0.420
RA-to-RX P.I.	1.9±1.5	1.6±1.4	0.260
SV-to-RX mean flow	38.6±25.2 ml/min	42.4±20.5 ml/min	0.612
SV-to-RX P.I.	2.0±0.9	1.8±1.4	0.095
Deaths	0	0	–
IABP complications	0	0	–
Stroke	0	1 (2.3%)	0.315
Acute Myocardial Infarction	1 (2.3%)	0	0.315
Low Output Syndrome	1 (2.3%)	1 (2.3%)	0.753
Atrial Fibrillation	27 (60.0%)	23 (51.1%)	0.335
Respiratory Failure	2 (4.5%)	3 (6.7%)	0.645
Inotropes High Doses	3 (6.7%)	2 (4.5%)	0.645
Inotropes Medium Doses	10 (22.2%)	8 (17.7%)	0.598
Intubation time (hours)	19.4±4.6	17.8±5.2	0.321
ITU stay (days)	2.5±1.7	2.2±2.0	0.163
Hospital stay (days)	8.7±1.4	8.1±1.9	0.269

ACC: Aortic cross-clamp; CPB: Cardio-pulmonary bypass; ITU: intensive therapy unit; LIMA: left internal mammary artery; RA: radial artery; RX: right coronary artery; SV: saphenous vein.

Table III.  TTF results of sSV-CABG and seqSV-CABG on the circumflex territory at baseline and during IABP-induced recruitment of the graft flow reserve.

	Group A (sSV-CABG)	Group B (seqSV-CABG)	*p^1	*p^2
Maximum Flow (ml/min)	62.4±29.6	119.1±57.5	0.001	–
Mean Flow (ml/min)	30.8±12.8	56.3±31.5	0.0001	–
Minimum Flow (ml/min)	11.8±8.9	22.8±9.2	0.001	–
P.I.	1.46±0.9	0.71±0.4	0.006	–
1:1 IABP Mean Flow (ml/min)	42.3±15.2	95.4±29.7	0.0001	SSV-CABG 0.009
				SeqSV-CABG 0.007
1:1 IABP P.I.	2.42±1.1	1.34±0.9	0.004	SSV-CABG 0.01
				SeqSV-CABG 0.01
Graft Flow Reserve	1.32±1.09	1.72±0.99	0.001	–

sSV-CABG: single saphenous vein CABG on the best obtuse marginal; seqSV-CABG: sequential saphenous vein CABG on the best 2 obtuse marginals; P.I.: pulsatility index; IABP: intraaortic balloon pump.

* p¹=sSV-CABG vs. seqSV-CABG; p²=1:1 IABP vs. baseline (IABP off).

Table IV.  Echocardiographic segmental Wall Motion Score Index results of sSV-CABG and seqSV-CABG on the circumflex territory.

	Pre-operative	Post-operative	Follow-up	*p^1	*p^2	*p^3	*p^4
Group A (sSV-CABG)	1.68±0.46	1.49±0.55	1.32±0.65	0.037	0.045	0.315	0.198
Group B (seqSV-CABG)	1.73±0.31	1.42±0.39	1.28±0.48	0.001	0.03

* p¹=preoperative WMSI vs. postoperative WMSI; p²=postoperative WMSI vs. follow-up WMSI; p³=postoperative WMSI recovery of sSV-CABG vs. postoperative WMSI recovery of seqSV-CABG; p⁴=follow-up WMSI recovery of sSV-CABG vs. follow-up WMSI recovery of seqSV-CABG.