[Methods of Coronary Anastomosis]

Abstract

In recent years, percutaneous coronary intervention (PCI) has been performed for left main trunk lesions and severe three-vessel lesions, which were previously considered indications for coronary artery bypass grafting( CABG). As a result, more patients with poorer general conditions or vascular characteristics are being considered for CABG. In the current era of PCI, surgeons are required to achieve high bypass graft patency and to perform anastomosis according to the coronary artery lesion and the characteristics of the bypass graft. There are two types of distal anastomosis for bypass grafts:end-toside and side-to-side. End-to-side anastomosis is a commonly used method in many institutions. Because the cuff-like anastomotic morphology of the end-to-side anastomosis has been reported to have a hydrodynamic advantage in blood flow at the anastomotic site, end-to-side anastomosis needs to be cuff-shaped. On the other hand, side-to-side anastomosis is reported to be easier to anastomose even when there is a mismatch in vessel diameter between the coronary artery and the bypass graft because the coronary artery incision and the bypass graft incision are more easily aligned in plan. In addition, extensive revascularization( onlay-patch grafting) is used for diffuse lesions in the coronary arteries. This section focuses on each method of coronary anastomosis.