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J Thorac Cardiovasc Surg 1996;112:69-78
© 1996 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

DIFFERENT CLINICAL OUTCOME IN CORONARY ARTERY BYPASS WITH SINGLE AND SEQUENTIAL VEIN GRAFTS: A FIFTEEN-YEAR FOLLOW-UP STUDY

B. L. van Brussel, MDa, H. W. M. Plokker, MD, PhDb, A. A. Voors, MDb, J. M. P. G. Ernst, MD, PhDb, J. C. Kelder, MDc, P. J. Knaepen, MDd, F. E. E. Vermeulen, MDd

Received for publication Feb. 15, 1995 Accepted for publication Oct. 3, 1995. Address for reprints: B. L. van Brussel, MD, Diaconessenhuis, Department of Cardiology, PO Box 90.052, 5600 PD Eindhoven, The Netherlands.

Abstract

Objective: In trying to answer the question about the controversial use of sequential grafts, we determined the long-term clinical outcome of patients in whom coronary artery bypass was done with different types of vein grafts. Methods: A total of 428 consecutive patients who underwent isolated coronary artery bypass with vein grafts between April 1, 1976, and April 1, 1977, were prospectively observed. In these patients three groups could be defined with single grafts only, sequential grafts only, and combined single and sequential grafts. Follow-up was 99.8% complete and averaged 15.4 years for the survivors. The Kaplan-Meier method and multivariate analysis done with the Cox regression model were used for survival, myocardial infarction, reintervention, and "any event." Results: Perioperative mortality and perioperative myocardial infarction rate were not statistically different among the three groups. During follow-up more myocardial infarctions (hazard ratio: 2.06; 95% confidence interval: 1.08 to 3.93; p = 0.0293) or any events (hazard ratio: 1.54; 95% confidence interval: 1.01 to 2.36; p = 0.0450) occurred in patients with sequential grafts only than in patients with single grafts only. Conclusion: Although more complete revascularization was obtained in patients with sequential vein grafts only, more events during a 15-year follow-up occurred in these patients than in patients with single vein grafts only. (J THORAC CARDIOVASC SURG 1996;112:69-78)




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