Coronary Artery Bypass Graft Surgery: Relative Efficacy of Initial Proximal versus Distal Anastomoses

• Published in: The Annals of thoracic surgery Vol. 38; no. 1; pp. 15 - 20
• Main Authors: Roberts, Arthur J., Faro, Richard S., Watson, William D., Knauf, Daniel G., Hankins, Thomas, Alexander, James A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.1984; Elsevier Science
• Subjects: Angina Pectoris - physiopathology; Angina Pectoris - surgery; Biological and medical sciences; Cardiology. Vascular system; Clinical Trials as Topic; Coronary Artery Bypass - methods; Coronary heart disease; Creatine Kinase - blood; Electrocardiography; Evaluation Studies as Topic; Heart; Hemodynamics; Humans; Isoenzymes; Medical sciences; Prospective Studies; Random Allocation; Thermography; Time Factors; Autograft; Aortocoronary; Vein; Bypass; Coronary heart disease; Surgery
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(10)62178-9

Controversy exists concerning the most appropriate sequence of anastomoses in coronary artery bypass grafting (CABG) procedures. While the more commonly employed method of distal coronary anastomoses first has withstood a long clinical experience, a recent study and several cardiac surgical groups have suggested that construction of the proximal anastomoses first offers certain advantages. In 30 patients undergoing CABG, we performed a prospective, randomized trial comparing both techniques. Relative efficacy was assessed by hemodynamic, radionuclide, electrocardiographic, enzymatic, thermographic, and clinical evaluation. The length of cardiopulmonary bypass was longer in the group having the distal anastomoses done first. Myocardial temperature mapping was similar between groups. Hemodynamic changes, including cardiac output, ejection fraction, and regional wall motion, were nearly identical between the groups. The incidence of myocardial damage reflected by levels of myocardial-specific isoenzymes (serum CK-MB) and electrocardiographic changes was also similar. In conclusion, the sequence of anastomoses is not critical in routine CABG operations. However, we speculate that each technique may have certain advantages under different clinical circumstances found on occasion. Ideally, each method should be part of the coronary surgeon's armamentarium.