Outcomes of single versus sequential vein grafts in isolated coronary artery bypass surgery: Insights from a large tertiary care center

Ibrahim Gadelkarim; Viktor Kuzmenko; Suzanne de Waha; Nikhil Deshmukh; Otto Wolfgang; Thilo Noack; Salil V Deo; Martin Misfeld; Diyar Saeed; Piroze M Davierwala; Michael A Borger; Alexander Verevkin

doi:10.1016/j.jtcvs.2024.10.026

Outcomes of single versus sequential vein grafts in isolated coronary artery bypass surgery: Insights from a large tertiary care center

J Thorac Cardiovasc Surg. 2024 Oct 26:S0022-5223(24)00936-X. doi: 10.1016/j.jtcvs.2024.10.026. Online ahead of print.

Affiliations

¹ Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
² Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
³ Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁴ Department of Cardiac Surgery, Heart Center, Krefeld, Germany.
⁵ Division of Cardiovascular Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany. Electronic address: michael.Borger@helios-gesundheit.de.

PMID: 39490967
DOI: 10.1016/j.jtcvs.2024.10.026

Abstract

Background: Saphenous venous grafts remain the most widely used conduits in coronary artery bypass graft surgery (CABG). Data comparing outcomes of single saphenous venous grafting (SinCABG) versus sequential venous grafting (SeqCABG), however, are limited.

Methods: Between 2002 and 2012, 2375 patients with 3-vessel coronary artery disease underwent isolated elective CABG at the Leipzig Heart Center with a left internal mammary artery graft to left anterior descending artery and ≥2 distal saphenous vein graft anastomoses. Of these, 1278 received ≥2 singular saphenous venous grafts (SinCABG) and 563 received ≥1 sequential saphenous vein grafts with >1 distal anastomoses (SeqCABG). The primary end point was long-term survival. Secondary outcomes included short-term survival, early postoperative outcomes as well as early and late graft patency.

Results: At 30 days, mortality was 1.3% after SinCABG as compared with 2.3% after SeqCABG (P = .13). The postoperative complications rate did not differ between groups. Early postoperative coronary angiographies were performed in 127 patients (7%), whereas clinically indicated follow-up coronary angiographies were performed in 372 patients (20%) over a median follow-up of 5 years (interquartile range, 1.7-8.9). No differences in early or late patency rates were found between both grafting techniques (P = .79 and P = .39, respectively). The median duration of long-term clinical follow-up was 8.4 years (interquartile range, 5.6-11.4). Long-term survival rates at 1, 5, 10, and 15 years in SinCABG versus SeqCABG were 95% versus 94%, 83% versus 82%, 63% versus 62%, and 47% versus 41%, respectively (P = .22).

Conclusions: Short- and long-term mortality as well as early and late graft patency rates did not differ in patients undergoing SinCABG as compared with patients undergoing SeqCABG.

Keywords: coronary artery bypass grafting; graft patency; outcomes; saphenous vein grafts; sequential venous grafting; single saphenous venous grafting.