Angiographic assessment of sequential and individual coronary artery bypass grafting.
OBJECTIVE
In trying to answer the question about the controversial use of sequential grafts, we determined the mid-term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts.


METHODS
A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 +/- 17.6 months after coronary artery bypass grafting.


RESULTS
The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (< 1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%).


CONCLUSIONS
The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency.
Farsak
Bora
B
Department of Thoracic and Cardiovascular Surgery, Bayindil Hastanesi Ankara, Kizilirmak mah.28.sok., No: 2 Söğütözü, Ankara, Turkey. borafarsak@isnet.net.tr
Tokmakoglu
Hilmi
H
Kandemir
Ozer
O
Günaydin
Serdar
S
Aydin
Hakan
H
Yorgancioglu
Cem
C
Süzer
Kaya
K
Zorlutuna
Yaman
Y
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