OBJECTIVE

To analyze in-hospital outcomes of coronary artery bypass grafting (CABG) in patients with at least one target coronary artery (CA) with unverified distal bed (UDB).

MATERIAL AND METHODS

We analyzed in-hospital outcomes of CABG in 76 patients with at least one CA with UDB between September 1, 2022 and June 30, 2024. CA with UDB was analyzed after preoperative coronary angiography (CAG). Intraoperatively, we measured diameters (d) of all coronary arteries. Some patients (n=59) underwent intraoperative transit time flowmetry (TTFM). The rule of complete myocardial revascularization was observed, except for those coronary arteries that could not be technically bypassed. Coronary artery bypass grafts were divided into two groups: bypass grafts for CA with UDB (n=89) and bypass grafts for CA with verified distal bed (VDB) (n=208). In-hospital outcomes were analyzed.

RESULTS

Only 6 out of 95 CA (6.3%) with UDB were not suitable for CABG. They were too small (n=3, 3.2%) or absent as anatomical structures (n=3, 3.2%). Other 89 (83.7%) vessels were successfully bypassed, and their diameter did not significantly differed from CA with VDB. The incidence of d<1.5 mm was similar in both groups (53.9% vs. 44.4%, p=0.15). TTFM found no significant difference in flow through bypass grafts to CA with UDB and VDB. In 1 (1.3%) patient, myocardial infarction occurred in zone corresponding to bypassed CA with VDB. Other patients had no in-hospital angina and life-threatening cardiac arrhythmias. The mortality rate was 0%. All patients were discharged after 8 [8; 10.25] days.

CONCLUSION

Almost all CA assessed preoperatively as having UDB with preserved myocardium are intraoperatively visualized. They have sufficient diameter and anatomy for bypass grafting using microscope. Results of TTFM of bypass grafts to CA with UDB demonstrate no differences with bypass grafts to CA with VDB. In-hospital outcomes in patients with CA with UDB after CABG are satisfactory.