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The no-touch saphenous vein graft in elderly coronary bypass patients with multiple comorbidities is a promising conduit to substitute the left internal thoracic artery
Orebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-4249-8401
Örebro University, School of Medical Sciences. Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0003-3253-8967
Department of Surgery, Bayhealth Medical Center, Dover DE, USA.
Orebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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2017 (English)In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, S0022-5223(17)30558-5Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: We investigated the patency rates of no-touch saphenous vein grafts anastomosed to the left anterior descending artery compared with the left internal thoracic artery. Further, we compared the patency of no-touch vein grafts to the left anterior descending artery with the patency of no-touch vein grafts to other coronary arteries.

METHODS: Of 2635 consecutive patients undergoing coronary artery bypass grafting between 2003 and 2008, 168 (6.3%) were given at least a saphenous vein graft to the left anterior descending artery to avoid harvesting complications in high-risk patients or in response to a left internal thoracic artery injury. A total of 97 patients were consecutively included after informed consent. A clinical examination and computed tomography angiography were performed on 91 patients at a mean of 6 (4-9) years.

RESULTS: The mean age of patients was 75.6 ± 8.5 years. Postoperatively, 88.7% of patients (86/97) were free of angina. The 91 examined patients had 163 grafts with 286 distal anastomoses. Crude patency, according to distal anastomoses, was 94.4% (270/286). The patency of single versus sequential no-touch vein grafts to the left anterior descending artery was 98% (50/51) versus 92.5% (37/40). The total patency rate was 95.6% (87/91), similar to the reported patency rate for the left internal thoracic artery. The no-touch grafts to the left anterior descending artery versus other coronaries had a patency of 95.6% (87/91) versus 93.8% (183/195), a high similarity confirmed by an equivalence analysis.

CONCLUSIONS: In elderly coronary bypass patients with multiple comorbidities, a no-touch saphenous vein graft is a promising substitute for the left internal thoracic artery.

Place, publisher, year, edition, pages
Mosby Inc. , 2017. S0022-5223(17)30558-5
Keyword [en]
bypass graft, computed tomography angiography, coronary artery bypass grafting, left internal thoracic artery, no-touch harvesting technique, patency, saphenous vein
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-57312DOI: 10.1016/j.jtcvs.2017.03.048PubMedID: 28433355OAI: oai:DiVA.org:oru-57312DiVA: diva2:1103729
Available from: 2017-05-30 Created: 2017-05-30 Last updated: 2017-05-30Bibliographically approved

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Samano, NinosGeijer, HåkanBodin, Lennart
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