Long-term patency of sequential and individual saphenous vein coronary bypass grafts

Objectives: The long-term patency rates for individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits are angiographically compared; the impact of native coronary vessel characteristics is investigated. Methods: A total of 875 distal coronary anastomoses on 500 SVGs were assessed in 430 patients at an average of 5.8±3 years after a coronary revascularization procedure. Results: The patency rates of sequential conduits were markedly higher than those of individual ones (82 vs. 68%, P = 0.0005). Also, the anastomoses on the sequential conduits had better patency (75 vs. 68%, P < 0.03). This difference was even more pronounced in coronary arteries of poor quality and small (≪1.5 mm) diameter (57 vs. 28% for the sequential grafts and individual grafts, respectively, P = 0.001). Also, when the most distally located coronary artery on a sequential graft was of poor run-off, the patency rate for the entire conduit was considerably low (42.5%). Conclusions: The patency of a sequential vein graft conduit is generally better than that of an individual one, especially for poor run-off coronary vessels, provided that the most distally located anastomosis is done on a good coronary artery in terms of quality and diameter. Using a minimal length of conduits is another advantage. However, failure of a single sequential conduit jeopardizes all the anastomoses along that graft segment. Besides, sequential grafting is technically more demanding, and the technical expertise in performing a sequential anastomosis is probably among the important determinants of short- and long-term patency.