title: A novel composite coronary bypass graft strategy: the saphenous vein bridge--a pilot study.
abstract: OBJECTIVE
  The aim of this pilot study was to describe and assess the safety of a novel composite graft technique for coronary artery bypass grafting (CABG) surgery. A saphenous vein is grafted to the left anterior descending artery (LAD) and other anterolateral coronary arteries, creating a saphenous vein bridge (SVB) and the left internal mammary artery (LIMA) is anastomosed to the SVB, distributing the blood flow distally (LIMA-SVB).
  
  
  METHODS
  All patients who underwent CABG with the LIMA-SVB between 2005 and 2008 at our centre were enrolled in this study. Perioperative data were retrospectively collected from hospital charts, and the clinical follow-up was completed by telephone interview. Graft patency was assessed by computed tomography angiography (CTA) in patients with the longest follow-up time (n = 20).
  
  
  RESULTS
  A total of 256 patients (mean age: 67 ± 12 years; 79% male) received 4.0 ± 1.0 grafts, including 2.2 ± 0.4 distal grafts provided by the LIMA-SVB. Nine (3.5%) deaths and 4 (1.6%) myocardial infarctions (MIs) were noted in the perioperative period. With a median follow-up time of 36 months [inter-quartile range 31-44], 1 (0.5%) MI and 2 (1.0%) strokes were reported. At 51 months post-surgery [47-53], CTA demonstrated a LIMA pedicle (n = 20) and SVB (n = 42) patency rate of 100 and 93%, respectively. Specifically, the LIMA-SVB patency rate was 100% to the LAD and 85% to diagonal arteries. Aortocoronary vein grafts (n = 38) patency rate in the same patients was 87%.
  
  
  CONCLUSIONS
  Revascularization of the anterolateral territory using the LIMA-SVB is a promising approach considering its clinical safety and favourable patency rate results. A prospective randomized clinical trial is underway to compare this technique to conventional CABG.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
authors.forename: Jan-Alexis
authors.initials: JA
authors.lastname: Tremblay
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Carl
authors.initials: C
authors.lastname: Chartrand-Lefebvre
authors.forename: Martin
authors.initials: M
authors.lastname: Chandonnet
authors.forename: Samer
authors.initials: S
authors.lastname: Mansour
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
authors.forename: Ignacio
authors.initials: I
authors.lastname: Prieto
authors.forename: Fadi
authors.initials: F
authors.lastname: Basile
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D010865:Pilot Projects; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Composite grafting; Coronary artery bypass grafting; Follow-up studies; Left internal mammary artery grafting; Saphenous vein grafting