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Angiographic Assessment of Sequential and Individual Coronary Artery Bypass Grafting
Author(s) -
Farsak Bora,
Tokmakoglu Hilmi,
Kandemir Özer,
Günaydin Serdar,
Aydin Hakan,
Yorgancioglu Cem,
Süzer Kaya,
Zorlutuna Yaman
Publication year - 2003
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1046/j.0886-0440.2003.02063.x
Subject(s) - medicine , anastomosis , artery , bypass grafting , vein , cardiology , surgery , coronary arteries , derivation
Objective : In trying to answer the question about the controversial use of sequential grafts, we determined the mid‐term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts. Methods : A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 ∓ 17.6 months after coronary artery bypass grafting. Results : The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (<1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%). Conclusions : The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency. (J Card Surg 2003;18:524‐529)