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

Abstract

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 AE 1.5 days), and 1 year postoperatively (n = 671, 12.1 AE 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. #

Comparison of Radial Artery and Saphenous Vein Composite Y Grafts during Off-pump Coronary Artery Bypass

“…Only a few studies conducted in a small number of patients have reported results of CABG using SV composite grafts, and this graft configuration is controversial [6-8,14]. The SV graft may be regarded as a major ITA collateral branch whose caliber is significantly larger than that of the main artery itself.…”

Ten-year experience with off-pump coronary artery bypass grafting: Lessons learned from early postoperative angiography

“…A significantly lowered patency for saphenous vein grafts relative to ITA grafts has been suggested to result from the type of graft, presence of dyslipidemia, exposure and quality of stabilization, and increased procoagulatory activity in OPCAB patients. 10,15,16 A previous study that used early postoperative angiography 17 demonstrated an overall graft patency rate among patients who received venous grafts significantly lower than that among patients who received total arterial grafts. Multivariable logistic regression analysis failed to demonstrate early experience as an independent predictor, and venous graft use itself was an independent predictor of graft failure during the first postoperative year after OPCAB.…”

Off-pump coronary artery revascularization in octogenarians: is it better?

“…Although prospective randomized trials carried in the hands of surgeon with high level of expertise have shown that early patency and adequacy of the revascularization could be equivalent between on and off-pump revascularization [83,91], meta-analyses have reported a decrease in the number of grafts with OPCAB surgery and a lower patency rate especially with vein graft [92,93]. However, recent studies tend to demonstrate similar transit-time flowmetric results, as well as comparable graft flow reserve with both techniques [94].…”