OBJECTIVE: Several factors are involved in the preservation of graft function after surgical myocardial revascularization. This follow-up study aimed to evaluate the effects of vein graft anastomosis and graft morphology on long-term graft patency a minimum of 10 years after aortocoronary bypass grafting.Setting and Cohorts. This was a sub-analysis of a study that enrolled patients after isolated bypass surgery at the University Hospital Ostrava in order to evaluate the long-term graft patency of the saphenous vein after endoscopic harvest, a minimum of 10 years after aortocoronary bypass grafting. METHODS: Fifty angiograms, with a total of 90 grafts, after isolated myocardial revascularization were visualized using coronary computed tomography angiography, with 50% luminal stenosis or greater considered significant. RESULTS: The overall graft patency rate was 72.3%. The differences in occlusion rates between sequential and individual grafts were not statistically significant (P=0.156). All y-grafts were totally occluded. Graft and target artery diameters had a statistically significant influence on patency (P=1.000 and 0.381, respectively). Longer graft length and higher calcium scores were associated with statistically significant graft occlusion (P=0.033 and 0.005, respectively). CONCLUSION: Sequential grafts can be constructed safely, especially when the goal is complete myocardial revascularization.

Department of Cardiac Surgery University Hospital Ostrava Ostrava Czech Republic

Department of Radiology University Hospital Ostrava Ostrava Czech Republic

Department of Science and Research University Hospital Ostrava Ostrava Czech Republic

Faculty of Medicine University of Ostrava Ostrava Czech Republic

See more in PubMed

Barner HB, Farkas EA. Conduits for coronary bypass: vein grafts. Korean J Thorac Cardiovasc Surg 2012;45(5):275-86. doi: 10.5090/kjtcs.2012.45.5.275 PubMed DOI

Mehta RH, Ferguson TB, Lopes RD, Hafley GE, Mack MJ, Kouchoukos NT, Gibson CM, Harrington RA, Califf RM, Peterson ED, Alexander JH; Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Investigators. Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. Circulation 2011;124(3):280-8. doi: 10.1161/CIRCULATIONAHA.110.991299 PubMed DOI

Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Rodés-Cabau J, Goldman S, Shunk KA, Mavromatis K, Banerjee S, Alaswad K, Nikolakopoulos I, Vemmou E, Karacsonyi J, Alexopoulos D, Burke MN, Bapat VN, Brilakis ES. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation 2021;144(9):728-45. doi: 10.1161/CIRCULATIONAHA.120.052163 DOI

Janiec M, Dimberg A, Lindblom RPF. Symptomatic late saphenous vein graft failure in coronary artery bypass surgery. Interdiscip Cardiovasc Thorac Surg 2023;36(4):ivad052. doi: 10.1093/icvts/ivad052 PubMed DOI

Harik L, Perezgrovas-Olaria R, Soletti G Jr, Dimagli A, Alzghari T, An KR, Cancelli G, Gaudino M, Sandner S. Graft thrombosis after coronary artery bypass surgery and current practice for prevention. Front Cardiovasc Med 2023;10:1125126. doi: 10.3389/fcvm.2023.1125126 DOI

Onorati F, Pezzo F, Esposito A, Impiombato B, Comi MC, Polistina M, Renzulli A. Single versus sequential saphenous vein grafting of the circumflex system: a flowmetric study. Scand Cardiovasc J 2007;41(4):265-71. doi: 10.1080/14017430701283864 DOI

Vural KM, Sener E, Taşdemir O. Long-term patency of sequential and individual saphenous vein coronary bypass grafts. Eur J Cardiothorac Surg 2001;19(2):140-4. doi: 10.1016/s1010-7940(00)00629-1 PubMed DOI

Gaudino M, Antoniades C, Benedetto U, Deb S, Di Franco A, Di Giammarco G, Fremes S, Glineur D, Grau J, He GW, Marinelli D, Ohmes LB, Patrono C, Puskas J, Tranbaugh R, Girardi LN, Taggart DP; ATLANTIC (Arterial Grafting International Consortium) Alliance. Mechanisms, Consequences, and Prevention of Coronary Graft Failure. Circulation 2017;136(18):1749-64. doi: 10.1161/CIRCULATIONAHA.117.027597 PubMed DOI

Muto A, Model L, Ziegler K, Eghbalieh SD, Dardik A. Mechanisms of vein graft adaptation to the arterial circulation: insights into the neointimal algorithm and management strategies. Circ J 2010;74(8):1501-12. doi: 10.1253/circj.cj-10-0495 PubMed DOI

Ouzounian M, Hassan A, Yip AM, Buth KJ, Baskett RJ, Ali IS, Hirsch GM. The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting. Eur J Cardiothorac Surg 2010;38(5):579-84. doi: 10.1016/j.ejcts.2010.03.008 PubMed DOI

Grondin CM, Limet R. Sequential anastomoses in coronary artery grafting: technical aspects and early and late angiographic results. Ann Thorac Surg 1977;23:1-8. doi: 10.1016/s0003-4975(10)64059-3 PubMed DOI

Abazid RM, Romsa JG, Akincioglu C, Warrington JC, Bureau Y, Kiaii B, Vezina WC. Coronary artery calcium progression after coronary artery bypass grafting surgery. Open Heart 2021;8(1):e001684. doi: 10.1136/openhrt-2021-001684 PubMed DOI

Mohsin I, Namburu L, Sadiq Z, Newberry B, Ahmed HM. Competitive Flow: Closure of Internal Thoracic Artery Graft After Successful Coronary Artery Bypass Graft Surgery. CJC Open 2021;3(11):1406-9. doi: 10.1016/j.cjco.2021.06.017 PubMed DOI

Kieser TM, FitzGibbon GM, Keon WJ. Sequential coronary bypass grafts. Long-term follow-up. J Thorac Cardiovasc Surg 1986;91(5):767-72. DOI

Park SJ, Kim HJ, Kim JB, Jung SH, Choo SJ, Lee JW, Chung CH. Sequential Versus Individual Saphenous Vein Grafting During Coronary Arterial Bypass Surgery. Ann Thorac Surg 2020;109(4):1165-73. doi: 10.1016/j.athoracsur.2019.07.094 PubMed DOI

Harik L, Perezgrovas-Olaria R, Soletti G Jr, Dimagli A, Alzghari T, An KR, Cancelli G, Gaudino M, Sandner S. Graft thrombosis after coronary artery bypass surgery and current practice for prevention. Front Cardiovasc Med 2023;10:1125126. doi: 10.3389/fcvm.2023.1125126 PubMed DOI

Li J, Liu Y, Zheng J, Bai T, Liu Y, Wang X, Liu N, Cheng L, Chen Y, Zhang H. The patency of sequential and individual vein coronary bypass grafts: a systematic review. Ann Thorac Surg 2011;92(4):1292-8. doi: 10.1016/j.athoracsur.2011.05.038 PubMed DOI