Coronary Artery Bypass Grafting With Y-Saphenous Vein Grafts
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19.06.2009, 14:47
Introduction: The saphenous vein is one of the indispensible grafts for coronary revascularization despite the advantages of arterial grafts over veins. It can be used in different configurations with different anastomosis (eg, sequential, composite, or Y-graft) techniques. Our aim was to investigate early and midterm results of Y-type anastomosis of saphenous vein grafts for complete coronary revascularization. Material and methods: Coronary artery bypass grafting (CABG) with Y-graft technique was performed in 512 patients between February 1998 and June 2007. In total, 608 saphenous Y coronary anastomoses were performed. These anastomoses were on first and second obtuse marginal arteries (n: 323), first diagonal and first obtuse marginal arteries (n: 187), posterolateral and posterior descending artery (n: 79), and right coronary artery and posterior descending artery (n: 19). Endareterectomy was performed in 28 patients with severely calcified coronary arteries. Patients were evaluated for early and late survival, newly developing cardiac events, recurring angina, and reinterventions. Results: In the early postoperative period, new myocardial infarction (MI) occurred in 27 (5.2%) patients and mortality in 13 (2.5%). Follow-up included the results of 487 (98%) patients. Mean follow-up duration was 56 + 24 months. Late mortality occurred in 36 (7.3%) patients, and in 13 (2.6%) patients new MI developed in the remote follow-up. Overall survival including all deaths at 3, 5, and 7 years was 94 + 0.6%, 86 + 1.3%, and 83 + 2.1%, respectively, and actuarial freedom from angina recurrence at 3, 5, and 7 years was 95.2 + 2.5%, 86.4 + 3%, and 84.7 + 4.6%, respectively. Among long-term survivors, 116 patients (25.7%), 49 being symptomatic, with 123 saphenous Y-type anastomoses having undergone angiography studies. Saphenous vein Y grafts were completely patent in 94 anastomoses (76.4%). Conclusions: Saphenous vein Y-type anastomosis technique can safely be used in patients with multivessel coronary artery disease (CAD) with successful longterm outcomes. As with sequential anastomosis, the safety of the technique may be attributed to the distribution of inflow from aorta into multiple vessels.
