Sequential Venous Bypass Grafts: Results 10 Years Later

Background. To evaluate the long-term outcome of the sequential vein bypass grafting technique, we studied 92 patients with coronary artery disease undergoing coronary artery bypass grafting in 1984 by one surgeon and receiving at least one sequential vein bypass graft (total of 170 sequential bypass grafts). Methods. There was one hospital death and 1 patient was lost to follow-up. The remaining 90 patients were followed up by clinical evaluation, and 80% of the patients underwent coronary angiography within 1 year from the end point of the follow-up (June 1995), or before recurrence of symptoms or death. Results. All patients except 3 had improvement of their angina class (Canadian Cardiovascular Society) at the end of the follow-up. Twelve patients did not have improvement of their New York Heart Association functional class postoperatively, but only 1 deteriorated. The mean left ventricular ejection fraction remained unchanged at the end of the follow-up period, and ergometry results were satisfactory during the follow-up period. The 10-year survival rate was 74%, and the cardiac event-free survival rate was 72%. Only 37% of the deaths occurring during the follow-up were cardiac-related deaths. In 56 patients with angiographic routine control 9 to 10 years postoperatively, 76 of 89 sequential vein grafts were found patent. Conclusions. It is thought that the optimal long-term results of sequential bypass grafts may be dependent on where the terminal anastomosis of the sequence (the end-to-side anastomosis) is placed. The technique of sequential grafting with the reversed saphenous vein is easier to employ than the single grafting technique, and in the present study has been demonstrated to have good long-term results. Furthermore, it allows for a more complete revascularization of the myocardium, which is particularly important in patients with diffuse coronary artery disease. (Ann Thorac Surg 1997;63:371–6)