title: Saphenous vein to internal mammary artery end-to-end composite grafts for coronary artery bypass. Late follow-up.
abstract: BACKGROUND
  Internal mammary artery (IMA) grafts provide equal or superior graft patency compared to other conduits. The IMA length limits extensive myocardial revascularisation with IMA grafts alone. This study aimed to determine the results of lengthening free IMAs with a short proximal segment of saphenous vein (SV) to enable more extensive myocardial revascularisation.
  
  
  METHODS
  Patients (n=92) who underwent end-to-end composite SV-IMA grafts were followed up through cardiology and death register databases.
  
  
  RESULTS
  The mean patient age was 57.5 years and median follow up 10.9 years. There was no perioperative mortality and 10-year survival was 89.6%. Thirty-one patients (34%) underwent repeat angiography at a median of 2.8 years postoperatively. The 10-year freedom from angiography showing SV segment occlusion was 89% with a median time to angiography of 2.3 years (nine patients). The number of distal anastomoses was the only independent predictor of SV segment occlusion HR per anastomosis=0.26 (p=0.01). In five sequential grafts to the circumflex and right coronary systems, the IMA portion of the graft remained patent following SV segment occlusion.
  
  
  CONCLUSIONS
  Graft patency is improved by a greater number of coronary artery anastomoses.
authors.affiliation: Sydney Medical School, University of Sydney, NSW. Electronic address: patersonh@aol.com.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Paterson
authors.affiliation: Department of Cardiology, Westmead Hospital, Hawkesbury Rd, Westmead, NSW; Sydney Medical School, University of Sydney, NSW.
authors.forename: Jay
authors.initials: J
authors.lastname: Thakkar
authors.affiliation: Research and Education Network, Westmead Hospital, Hawkesbury Rd, Westmead; Sydney Medical School, University of Sydney, NSW.
authors.forename: Karen
authors.initials: K
authors.lastname: Byth
authors.affiliation: Department of Cardiology, Westmead Hospital, Hawkesbury Rd, Westmead, NSW; Sydney Medical School, University of Sydney, NSW.
authors.forename: A Robert
authors.initials: AR
authors.lastname: Denniss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein
keywords: Composite graft; Coronary angiography; Coronary artery bypass surgery; Internal mammary artery; Ischaemic heart disease; Saphenous vein