Long-term patency of sequential and individual saphenous vein coronary bypass grafts.
OBJECTIVE
The long-term patency rates for individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits are angiographically compared; the impact of native coronary vessel characteristics is investigated.


METHODS
A total of 875 distal coronary anastomoses on 500 SVGs were assessed in 430 patients at an average of 5.8+/-3 years after a coronary revascularization procedure.


RESULTS
The patency rates of sequential conduits were markedly higher than those of individual ones (82 vs. 68%, P=0.0005). Also, the anastomoses on the sequential conduits had better patency (75 vs. 68%, P=0.03). This difference was even more pronounced in coronary arteries of poor quality and small (<1.5 mm) diameter (57 vs. 28% for the sequential grafts and individual grafts, respectively, P=0.001). Also, when the most distally located coronary artery on a sequential graft was of poor run-off, the patency rate for the entire conduit was considerably low (42.5%).


CONCLUSIONS
The patency of a sequential vein graft conduit is generally better than that of an individual one, especially for poor run-off coronary vessels, provided that the most distally located anastomosis is done on a good coronary artery in terms of quality and diameter. Using a minimal length of conduits is another advantage. However, failure of a single sequential conduit jeopardizes all the anastomoses along that graft segment. Besides, sequential grafting is technically more demanding, and the technical expertise in performing a sequential anastomosis is probably among the important determinants of short- and long-term patency.
Vural
K M
KM
Cardiovascular Surgery Department, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. kvural@tr.net
Sener
E
E
Taşdemir
O
O
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation*; D014654:Vascular Patency