Coronary artery bypass with "snake" grafts: fifteen-year follow-up

Since 1970 we have used the "snake" graft in more than 8000 cases of coronary artery bypass grafting (CABG). We followed, for over 15 years, 214 patients who underwent CABG in 1981 with only a "snake" graft by one surgeon (William H. Sewell, M.D.).

Eighty-four percent (180/214) were male and 16% (34/214) were female with an average age of 58 and 66 years, respectively. The average left ventricular ejection fraction (LVEF) was > 55% in 63% (135/214) of the patients and < 55% in 37% (79/214); 15% (33/214) had diabetes and 77% (164/214) were smokers. The mean preoperative New York Heart Association (NYHA) functional class was 3.1+/-0.6 (range I-IV). Diagnostic arteriography demonstrated two vessel disease in 5% (9/214), three vessel disease in 89% (191/214), and left main disease in 6% (14/214). The average number of distal grafts per patient was 3.4. Coronary arteriography was performed 8-weeks postoperatively. Annual follow-up with a questionnaire determined incidence of redo procedures and survival.

The perioperative 30-day mortality was 1% (2/214). At 8 weeks there was a graft patency rate end-to-side of 85%, side-to-side 97%, and the proximal segment of 95%. Four percent (9/214) had redo surgery while 6% (13/214) underwent angioplasty during the 15 years. Sixty-seven percent (144/214) were alive at 15 years with a significantly improved mean NYHA functional class of 1.2+/-0.9 (p < 0.001). Twenty-four percent of those 166 live patients (35/144) had an average LVEF of 50% by echocardiography. There were 34 (16%) noncardiac deaths, 32 (15%) cardiac deaths, and 2 (1%) unknown causes.

The results of this study suggest that survival using the "snake" graft conduit is competitive with that observed using the internal mammary artery.