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Influence of vein graft use on postoperative 1-year results after off-pump coronary artery bypass surgery

^a Department of Thoracic and Cardiovascular Surgery, Halla General Hospital, Jeju-City, Jeju-Do, Korea
^b Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea

Received 14 May 2007; received in revised form 27 July 2007; accepted 1 August 2007.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel.: +82 2 2072 3482; fax: +82 2 747 5245. (Email: kimkb{at}snu.ac.kr).

Objective: We studied the postoperative 1-year results after off-pump coronary artery bypass surgery (OPCAB) with one or more saphenous vein grafts. Methods: We compared the clinical and angiographic results of 833 patients who underwent OPCAB between 1998 and 2004. Group 1 patients (n = 135) received one or more vein grafts. Group 2 patients (n = 698) received total arterial grafts. Coronary angiographies were performed early postoperatively (n = 804, 1.6 ± 1.5 days), and 1 year postoperatively (n = 671, 12.1 ± 4.2 months). Results: There were no significant differences in patient characteristics, operative mortalities, and morbidities between the two groups (p = ns). Both the early postoperative and 1-year angiographies demonstrated significantly lower overall graft patency rates in group 1 than in group 2 (early: 90.9% vs 99.1%, p < 0.001; 1 year: 78.8% vs 95.1%, p < 0.001), which might be affected by the lower vein graft patency rates in group 1 (early: 86.4%; 1 year: 67.9%). There was no difference in the 1-year patency of internal thoracic arteries between the two groups (94.3% vs 95.6%, p = 0.402). Multivariate analysis demonstrated the use of vein graft (Odds ratio = 5.204, p < 0.001) as an independent predictor of graft failure during the first postoperative year. Target vessel revascularization rate during the postoperative 1 year was significantly higher in group 1 than in group 2 (7.4% vs 2.0%, p = 0.002). Conclusions: Our study revealed that saphenous vein graft use in OPCAB independently predicted the graft failure while increasing the target vessel revascularization rate during the first postoperative year. Exclusive arterial revascularization would be a preferable strategy in OPCAB.

Key Words: Coronary artery bypass grafting • Off-pump CABG • Graft patency