Baudo Massimo, Cabrucci Francesco, Yakobitis Amanda, Murray Courtney, Torregrossa Gianluca
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA, United States.
Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, United States.
Front Cardiovasc Med. 2025 Mar 3;12:1555394. doi: 10.3389/fcvm.2025.1555394. eCollection 2025.
Numerous techniques have been developed to minimize risk of perioperative stroke during coronary artery bypass grafting (CABG), including off-pump approach, preoperative and intraoperative imaging of the ascending aorta (CT scan and epiaortic ultrasound), anaortic CABG with bilateral internal thoracic artery, clampless devices for the construction of proximal anastomosis and minimal aortic manipulation with a single aortic inflow for all proximal grafts (piggyback proximal anastomosis). The aim of this study was to evaluate the clinical outcomes of CABG patients who underwent off pump CABG with proximal anastomosis constructed with the use of a clampless device and in a piggyback fashion.
This observational study included 112 consecutive patients undergoing CABG with the piggyback proximal technique at the Lankenau Heart Institute between June 2021 and January 2024. Primary endpoints included overall mortality, cardiac-related mortality, stroke, myocardial infarction, repeat revascularization. Intraoperative transit time flow measurement (TTFM) was also analyzed.
The mean age of the cohort was 67.8 ± 8.7 years, with 75.9% (85/112) being male. All patients underwent off-pump CABG. The piggyback anastomosis consisted of vein-on-vein (52.7%, 59/112), artery-on-vein (43.8%, 49/112), and double vein/artery configurations (3.6%, 4/112). Postoperatively, no strokes occurred. At 30 days no patient died or required repeat revascularization. The mean hospital stay was 5.5 [4.0-8.0] days. At a mean follow-up of 1.0 [0.5-1.7] years, no cardiac deaths were recorded, with an overall survival of 98.2% (110/112). Repeat piggyback revascularization was 3.6% (4/112) at a mean of 2.0 ± 0.5 years. TTFM demonstrated superior flow rates in artery-on-vein grafts [50 (40-70) ml/min] compared to vein-on-vein grafts [40 (30-53.5), < 0.001].
When a proximal anastomosis cannot be avoided during off pump CABG, the combination of a piggyback proximal anastomosis together with the use of a clampless aortic device, demonstrated promising early mid-term outcomes almost nullifying the perioperative risk of clinical stroke. Intraoperative TTFM showed excellent flow rates, especially when arterial grafts were used. The technique is a viable option in high-risk patients with severe aortic disease, offering a safe and effective approach to multivessel revascularization with minimal aortic manipulation. Further studies with longer follow-up are warranted to confirm its long-term benefits.
为将冠状动脉搭桥术（CABG）围手术期卒中风险降至最低，已开发出多种技术，包括非体外循环方法、升主动脉术前及术中成像（CT扫描和主动脉外膜超声）、采用双侧胸廓内动脉的非主动脉CABG、用于构建近端吻合口的无钳夹装置以及对所有近端移植物采用单一主动脉流入道的最小主动脉操作（背驮式近端吻合术）。本研究的目的是评估采用无钳夹装置并以背驮式方式构建近端吻合口的非体外循环CABG患者的临床结局。
本观察性研究纳入了2021年6月至2024年1月期间在兰肯瑙心脏研究所连续接受背驮式近端技术CABG的112例患者。主要终点包括全因死亡率、心脏相关死亡率、卒中、心肌梗死、再次血运重建。还分析了术中通过时间流量测量（TTFM）。
该队列的平均年龄为67.8±8.7岁，男性占75.9%（85/112）。所有患者均接受非体外循环CABG。背驮式吻合包括静脉对静脉（52.7%，59/112）、动脉对静脉（43.8%，49/112）和双静脉/动脉构型（3.6%，4/112）。术后无卒中发生。30天时无患者死亡或需要再次血运重建。平均住院时间为5.5[4.0 - 8.0]天。平均随访1.0[0.5 - 1.7]年，无心脏死亡记录，总生存率为98.2%（110/112）。平均2.0±0.5年时再次背驮式血运重建率为3.6%（4/112）。TTFM显示动脉对静脉移植物的流速[50（40 - 70）ml/min]优于静脉对静脉移植物[40（30 - 53.5），<0.001]。
在非体外循环CABG期间无法避免近端吻合时，背驮式近端吻合与使用无钳夹主动脉装置相结合，显示出良好的早期中期结局，几乎消除了临床卒中的围手术期风险。术中TTFM显示流速极佳，尤其是使用动脉移植物时。该技术对于患有严重主动脉疾病的高危患者是一种可行的选择，为多支血管血运重建提供了一种安全有效的方法，且主动脉操作最少。有必要进行更长时间随访的进一步研究以证实其长期益处。
