CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 244 AFRICA Proximal anastomoses were performed with side clamping in all patients. All distal anastomoses were performed with 7.0 prolene sutures, and all proximal anastomoses were performed with 5.0 prolene sutures. When haemodynamic stabilisation was achieved after the completion of the anastomoses, TTFMs were performed. Mechanical factors, such as torsion, spasms and air were primarily eliminated in the grafts that showed low PI values according to the TTFMs. Papaverine and nitroglycerin were used to eliminate any possible spasms, especially in arterial grafts. Probes were sent from the grafts into the native vessels through incisions made just above the distal anastomoses in patients whose PI values did not improve after the interventions. With the aid of the Octopus, the anastomoses were renewed on the beating heart in patients who were considered to have stenosis in the anastomosis line. The procedure was terminated in patients who did not achieve the desired improvements in PI values despite technical intervention since there were no obvious changes in the electrogram. All procedures were recorded. Statistical analysis The Number Cruncher Statistical System 2007 (Kaysville, Utah, USA) program was used for the statistical analysis. In the assessment of the study data, the distribution of the data was evaluated with the Shapiro–Wilk test and descriptive statistical methods (mean, standard deviation, median, frequency, ratio, minimum and maximum). In the comparison of the quantitative data, an ANOVA test was used for three or more groups with normal distribution, and the Kruskal–Wallis test was used for the groups without normal distribution. Post hoc tests were used to determine the differences. A chi-squared test was used to analyse the qualitative data. Statistical significance was set at p < 0.01 and p < 0.05 levels. Results The mean ages of the patients in all three groups were 62.02 ± 9.66, 61.67 ± 9.56 and 61.38 ± 8.97 years, respectively. There were no statistical differences between them. The patients’ other demographic data are presented in Table 1. There were no significant differences between the EuroSCORE II evaluations of the groups (group 1: 1.17 ± 0.56, group 2: 1.43 ± 1.08 and group 3: 1.38 ± 0.82). On average, 3.19 ± 0.84, 2.79 ± 0.74 and 2.34 ± 0.9 grafts were used in the patients in groups 1 to 3, respectively. The left internal thoracic artery was used for the left anterior descending (LAD) artery in all patients (Table 2). The number of grafts used in the group undergoing cardiac arrest (group 1) under cardiopulmonary bypass was higher than in the other groups (p < 0.01). There were no significant differences between the groups in terms of intubation times, intensive care unit stay, service follow-up times and postoperative complications (Table 3). Although discharge times were found to be shorter in the patients undergoing surgery on the beating heart, these findings were not statistically significant. In total, 110 patients were measured for 313 grafts. Because LIMA grafts were used in all patients, the three groups were correctly compared in terms of the most important anastomoses. In the first measurement, the mean PI value was measured as 3.1 in 100 (90.9%) of 110 patients with LIMA grafts (PI ≤ 5). The flow was weak (PI ≥ 5) in five grafts (3.26%) in group 1, five grafts (5.43%) in group 2, and six grafts (8.82%) in group 3. Table 4 presents the measurements and problems detected in the grafts. First, the presence of any torsion in the grafts was checked. No additional interventions were required after changes in the position of the saphenous veins resulted in significant improvements to the PI values of two grafts in group 1. In patients with PI values > 5 in the LIMA–LAD anastomoses measurements, pre-anastomosis administration was performed, and local papaverine and nitroglycerin were administered on the LIMA grafts. The PI values increased to normal limits in Table 1. Demographic data of the patients Demographics Group 1 (n = 48) Group 2 (n = 33) Group 3 (n = 29) p-value Age (years) 62.02 ± 9.66 61.67 ± 9.56 61.38 ± 8.97 0.958 EuroSCORE II 1.17 ± 0.56 1.43 ± 1.08 1.38 ± 0.82 0.300 Gender, n (%) 0.283 Female 14 (29.2) 9 (27.3) 4 (13.8) Male 34 (70.8) 24 (72.7) 25 (86.2) COPD, n (%) 8 (16.7) 4 (12.1) 4 (13.8) 0.842 CRF, n (%) 1 (2.1) 0 (0.0) 0 (0.0) 0.521 Hypertension, n (%) 28 (58.3) 17 (51.5) 18 (62.1) 0.690 Hyperlipidaemia, n (%) 10 (20.8) 4 (12.1) 3 (10.3) 0.382 Diabetes mellitus, n (%) 17 (35.4) 16 (48.5) 14 (48.3) 0.395 PAD, n (%) 3 (6.2) 4 (12.1) 3 (10.3) 0.641 LVEF (%) 53.48 ± 7.7 50.94 ± 10.27 52.34 ± 7.31 0.416 COPD: chronic obstructive pulmonary disease, CRF: chronic renal failure, PAD: peripheral arterial disease, LVEF: left ventricular ejection fraction. Table 2. Number and locations of grafts used and technical problems Variables Group 1 (n = 48) Group 2 (n = 33) Group 3 (n = 29) Total number of grafts, n 153 92 68 LIMA–LAD anastomosis, n (%) 48 (100) 33 (100) 29 (100) Ao–Cx anastomosis, n (%) 39 (81.2) 27 (81.8) 15 (51.7) Ao–RCA anastomosis, n (%) 36 (75.0) 23 (69.6) 14 (48.2) Ao–DIA anastomosis, n (%) 30 (62.5) 9 (27.2) 10 (34.4) Curl in the grafts, n (%) 2 (1.3) 2 (2.17) 2 (2.94) Vasospasm, n (%) 2 (1.3) 2 (2.17) 2 (2.94) Anastomosis problem, n (%) 1 (0.65) 1 (1.08) 2 (2.94) LIMA: left internal mammary artery, LAD: left anterior descending artery, Ao: aorta, Cx: circumflex artery, RCA: right coronary artery, DIA: diagonal artery. Table 3. Operative and postoperative data of patients Variables Group 1 (n = 48) Group 2 (n = 33) Group 3 (n = 29) p-value Postoperative complication, n (%) 14 (29.2) 8 (24.2) 12 (41.4) 0.326 Intra-aortic balloon pump, n (%) 0 (0.0) 1 (3.0) 0 (0.0) 0.308 Positive inotropic support, n (%) 9 (18.7) 8 (24.2) 5 (17.2) 0.757 Number of grafts used, n (%) 3.19 ± 0.84 2.79 ± 0.74 2.34 ± 0.9 0.001* Duration of intensive care (h) 49.44 ± 11.72 60.27 ± 21.64 61.79 ± 28.25 0.096 Postoperative hospital stay (day) 5.54 ± 1.65 5.52 ± 0.87 5.83 ± 1.51 0.431 Operation time (min) 3.96 ± 0.68 4.03 ± 0.73 4.22 ± 0.62 0.161 *Kruskal–Wallis test.
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