The Annals of Thoracic Surgery, Vol 38, 15-20, Copyright © 1984 by The Society of Thoracic Surgeons
Coronary artery bypass graft surgery: relative efficacy of initial proximal versus distal anastomoses
AJ Roberts, RS Faro, WD Watson, DG Knauf, T Hankins and JA Alexander
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.
