Effect of Proximal Anastomotic Diameter on Venous Bypass Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting

Heart Surg Forum. 2015 Oct 28;18(5):E201-7. doi: 10.1532/hsf.1304.

Abstract

Background: In this study, the relationship between patency of saphenous vein (SV) graft and different sizes of aorta wall punches was investigated during the follow-up period after coronary artery bypass graft surgery. We also evaluated the other possible factors affecting SV graft patency.

Methods: This study consisted of 266 consecutive and symptomatic patients with postoperative angiography. The primary endpoint was at least one saphenous graft failure observed from coronary computed tomography angiography (cCTA) and/or invasive angiography after surgery. Groups were created as SV occluded and patent group. Survival curves of patients in groups were estimated using Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazard model.

Results: Cox-regression analysis demonstrated influence of older age (P = .023) and Diabetes Mellitus (DM) (P = .002) on SV graft failure. However, increasing ejection fraction (P = .011) was a protective factor against SV graft failure. There was no significant difference between the two groups in terms of usage rate of the punches with different diameters (P = .296).

Conclusion: The incidence of SV graft patency does not seem to increase in patients whose 4.8-mm aortic punch was used during proximal anastomosis compared to the reference group in which a punch of 4.0 mm was used. Also, the final proximal anastomosis graft size that was measured using cCTA was similar between patients with 4.8-mm punch and patients with 4-mm punch. Results from this study could help to determine which size for aortosaphenous anastomosis is clinically optimal.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Anastomosis, Surgical / adverse effects*
  • Anastomosis, Surgical / methods*
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / surgery*
  • Female
  • Graft Rejection / diagnostic imaging
  • Graft Rejection / etiology
  • Graft Rejection / prevention & control
  • Graft Survival*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Saphenous Vein / diagnostic imaging
  • Saphenous Vein / transplantation*
  • Treatment Outcome