[HSF] radial artery-vein patch

Donald Ross donross at bigpond.com
Mon Mar 3 14:09:40 EST 2008 

Here is  a little paper supporting the theoretical benefit of  
anaortic surgery:


ORIGINAL ARTICLE
Original Article 3
Anaortic Techniques Reduce Neurological Morbidity
After Off-Pump Coronary Artery Bypass Surgery
  Michael P. Vallely, PhD, FRACS∗, Kieron Potger, CCP, Darryl  
McMillan, CCP,
Jonathan M. Hemli, MB BS, MSc, PeterW. Brady, FRACS,
R. John L. Brereton, FRACS, David Marshman, FRACS,
Manu N. Mathur, FRACS and Donald E. Ross, FRACS
Department of Cardiothoracic Surgery, Royal North Shore Hospital,  
Sydney, NSW, Australia
Background: Stroke remains one of the most devastating complications  
of cardiac surgery. Advocates of off-pump
coronary revascularisation (OPCAB) maintain that post-operative  
neurologic morbidity is reduced by avoiding aortic
cannulation and cross-clamping, and by eliminating the systemic  
effects of cardiopulmonary bypass.We sought to determine
whether completing off-pump coronary surgery without any aortic  
manipulation (“anaortic” technique) afforded
any additional neurological protection, as compared to off-pump  
grafting in which the aorta was utilised for graft
inflow.

Methods:Acomprehensive review of prospectively collected data was  
undertaken of all patients undergoingOPCABin
our institution between January 2002 and December 2006. Cases  
requiring intra-operative conversion to cardiopulmonary
bypass were excluded from further analysis. Patients having OPCAB  
surgery with aortic manipulation were compared
to those having OPCAB surgery without aortic manipulation. Multiple  
logistic regression was used to identify possible
predictors of post-operative neurologic morbidity, with particular  
focus on the role of aortic manipulation.

Results: During the period of review, 1758 patients underwent OPCAB,  
of which 1201 (68.3%) were completed without
aortic manipulation, constituting the “anaortic” cohort. This  
group was compared with the remaining 557 patients, which
included fashioning at least one aorto-conduit anastomosis, utilising  
either a side-biting aortic clamp or a no-clamp
proximal anastomotic device. The two groups of patients were well- 
matched with respect to risk factors for adverse
neurologic outcomes. Nine patients sustained focal neurological  
deficits (transient or permanent) in the peri-operative
period, constituting a stroke rate of 0.51% for the entire series.  
The incidence of peri-operative neurological deficit in the
anaortic group was 0.25% compared with 1.1% in the aortic  
manipulation group (odds ratio (OR) 0.23, 95% confidence
interval (CI) 0.06–0.92, p = 0.037). Advanced age was also  
associated with peri-operative neurological injury (OR 1.1, 95%

Conclusions: Off-pump coronary artery surgery is associated with a  
low incidence of peri-operative stroke. Completing
the surgical procedure without manipulating the ascending aorta in  
any way (“anaortic” technique) offers additional
neurological protection and should be the goal in all suitable off- 
pump coronary cases.
(Heart, Lung and Circulation 2007;xxx:1–6)
© 2004 Published by Elsevier Inc on behalf of Australasian Society of  
Cardiac and Thoracic Surgeons and the Cardiac
Society of Australia and New Zealand.




On 03/03/2008, at 1:23 PM, Steven Schwartz wrote:

> We were concerned about potential injury to the IMA, which we felt  
> was not justifiable on a routine basis.
> My associates do not believe in the routine benefit of an  
> "anaortic" approach to CABG.
> We still use the IMA for the proximal if there is concern about the  
> length of the graft.
> Steven Schwartz
>
> On Mar 2, 2008, at 3:51 PM, Donald Ross wrote:
>
>> Steven,
>> Why did you abandon the radial-ima anastomosis in favour of the  
>> aorta?
>> I did the opposite, to gain extra reach for the radial and to keep  
>> clear of the aorta.
>> Don
>> On 03/03/2008, at 5:38 AM, Steven Schwartz wrote:
>>
>>> No. We've used radials extensively over the past 8 years. We  
>>> started putting the proximal to the LIMA, then moved to putting  
>>> the proximal directly to the aorta. We use 6-0 prolene for the  
>>> proximal anastamosis to the aorta and have not seen any problems.  
>>> The usual issues should be considered in selection of RAs and  
>>> targets in regards to degree of proximal stenosis.
>>> Steven Schwartz
>>>
>>> On Mar 2, 2008, at 8:20 AM, yadav del wrote:
>>>
>>>> I have seen some surgeons using vein or pericardial patch  cuff   
>>>> for proximal radial artery anastomosis  over aorta.
>>>>
>>>>   Is it necessary to do so?
>>>>
>>>>
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