Patency of Saphenous Vein Coronary Artery Bypass Grafts from the Vascular Prosthesis of the Ascending Aorta

Hidenori Sako, MD, PhD, Tetsuo Hadama, MD, PhD, Osamu Shigemitsu, MD, PhD, Shinji Miyamoto, MD, PhD, Hirofumi Anai, MD, PhD, and Tomoyuki Wada, MD, PhD

Background: Patients who have Stanford type A aortic dissection with impaired coronary arteries or who have aneurysms from the ascending aorta to the aortic arch with coronary artery disease need coronary artery bypass grafting (CABG) with tube graft replacement of the ascending aorta simultaneously. When vein grafts are used for CABG in these patients, the proximal anastomoses of vein grafts are attached to the prosthetic tube graft of the ascending aorta. However, the validity of proximal anastomoses of vein grafts to the prosthetic tube graft of the ascending aorta has not been confirmed.
Patients and Methods: We retrospectively analyzed patients who underwent venous coronary bypass grafting with prosthetic graft replacement of the ascending aorta. Between January 1984 and October 2002, 35 patients underwent CABG using saphenous vein grafts at the time of tube graft replacement of the ascending aorta, and the proximal anastomoses of the vein grafts were attached to the tube graft of the ascending aorta. Thirty-three venous bypass grafts were analyzed in 24 survivors.
Results: The postoperative catheterization showed only one early vein graft occlusion of 16 vein grafts anastomosed distally to the left anterior descending artery (LAD). All 14 venous grafts anastomosed to the right coronary artery (RCA) and 3 to the left circumflex artery (LCX) were patent. Therefore, the postoperative patency rate at discharge was 97.0% (32/33). Spiral computed tomography performed for long term follow-up revealed occlusion of two vein grafts (3.5 years and 9.7 years) anastomosed to the LAD.
Conclusions: The patency rate of vein grafts anastomosed from prosthetic grafts of the ascending aorta to the native coronary arteries was similar to that of conventional CABG using saphenous vein grafts. (Ann Thorac Cardiovasc Surg 2003; 9: 170-173)

Key words: CABG, vein graft, graft patency, vascular prosthesis, spiral computed tomography

From Department of Cardiovascular Surgery, Oita Medical University, Oita, Japan

Received November 15, 2002; accepted for publication December 26, 2002
Address reprint requests to Hidenori Sako, MD, PhD: Department of Cardiovascular Surgery, Oita Medical University, Hasama-machi, Oita 879-5593, Japan.

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