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Sequential vein bypass grafting: tactics and long-term results
J T Christenson1, F Simonet, M Schmuziger
1The Cardiovascular Surgery Unit, Columbia Hôpital de la Tour, Geneva, Switzerland.
Cardiovascular Surgery (London, England)
|September 2, 1998
Summary
Sequential vein bypass grafts offer advantages over single grafts, but failure in the antero-lateral position, especially with small or diseased vessels, carries higher risks of myocardial infarction and mortality. Postero-lateral sequential bypass graft occlusion has lower associated risks.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease.
- Sequential vein bypass grafting has emerged as an alternative to single grafts, offering potential advantages.
- Understanding the consequences of sequential bypass graft failure is crucial for optimizing surgical strategies.
Purpose of the Study:
- To evaluate the clinical outcomes and consequences of sequential bypass graft failure in patients undergoing primary coronary artery vein grafting.
- To compare the incidence of graft occlusion, reintervention, and adverse cardiac events between sequential and single bypass grafts.
- To identify specific anatomical or technical factors associated with increased risk of sequential graft failure.
Main Methods:
- Retrospective analysis of 3846 patients undergoing primary coronary artery bypass vein grafting between 1984 and 1996.
- Categorization of patients based on the type of graft used: sequential vein grafts versus single vein grafts (vein or internal thoracic artery).
- Long-term follow-up of hospital survivors to assess graft patency, symptomatic occlusions, re-do CABG, percutaneous transluminal coronary angioplasty, cardiac transplantation, and mortality.
Main Results:
- Overall hospital mortality was 2.1%, with lower rates in patients receiving sequential grafts (1.9%) compared to single grafts (3.7%).
- During a mean follow-up of 76 months, symptomatic sequential graft occlusions occurred in 4.5% of grafts, with higher rates for single vein grafts (9.9%).
- Postero-lateral sequential bypass graft occlusion was associated with low rates of myocardial infarction (3%) and mortality (7%), whereas antero-lateral sequential grafts had higher rates (22% MI, 68% mortality).
Conclusions:
- Sequential vein bypass grafting demonstrates favorable short-term and long-term outcomes compared to single grafts, particularly in the postero-lateral position when connected to high-flow vessels.
- Antero-lateral sequential vein grafts show better patency than single vein grafts but carry a higher risk of myocardial infarction and mortality upon occlusion.
- The use of single internal thoracic artery grafts may be safer in cases of small or severely diseased left anterior descending arteries, where antero-lateral sequential graft failure poses the highest risk.