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Eur J Cardiothorac Surg 2001;19:140-144
© 2001 Elsevier Science NL

Long-term patency of sequential and individual saphenous vein coronary bypass grafts

Kerem M. Vural, Erol ener, Oguz Tademir

Cardiovascular Surgery Department, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey

Received 30 March 2000; received in revised form 19 October 2000; accepted 17 November 2000.

Corresponding author. N. Tandogan cad. 5/6 Kavaklidere 06540, Ankara, Turkey. Tel.: +90-312-426-7574; fax: +90-312-426-6181
e-mail: kvural{at}tr.net

Objectives: 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.

Key Words: Sequential • Coronary • Bypass • Saphenous • Individual • Revascularization

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