Sequential versus conventional coronary artery bypass graft surgery in matched patient groups

The relative merits of sequential bypass grafting were compared to those of conventional bypass grafting in 247 patients undergoing uncomplicated coronary artery bypass graft surgery. The duration of both ischemic arrest and cardiopulmonary bypass could be predicted on the basis of the number of end-to-side and side-to-side anastomoses. Multivariate regression showed that sequential grafting can be executed more quickly than conventional grafting because: 1. the suture time for side-to-side anastomoses is less than that for end-to-side (5 vs. 12 min) and, 2. fewer aortic anastomoses are required. The rate of perioperative myocardial infarction was similar in both groups. In 109 patients recatheterized at one year, both groups improved equally in functional class, there was no significant difference in mortality, and graft patency was similar in both groups. The principal advantage of sequential grafting therefore is a shorter duration of ischemic arrest and cardiopulmonary bypass, while graft patency and the overall benefit of surgery remains the same.