Patency rate of the internal thoracic artery to the left anterior descending artery bypass is reduced by competitive flow from the concomitant saphenous vein graft in the left coronary artery

Abstract

In coronary artery bypass grafting (CABG), insufficient bypass flow can be a cause of occlusion or string sign of the internal thoracic artery (ITA) graft. A patent saphenous vein (SV) graft from the ascending aorta can reduce the blood flow through the ITA graft, and may affect its long-term patency. In the present study, we examined the impact of the patent SV graft to the left coronary artery on the long-term patency of the ITA to left anterior descending (LAD) artery bypass. We reviewed the coronary angiograms of 313 patients who had two bypasses to the left coronary artery including 1 in situ ITA to LAD graft between March 1986 and December 2006. Patients who had occlusion of either bypass grafts to the left coronary artery in the early angiography, were excluded. In 64 patients (20.4%), bilateral ITAs were individually anastomosed to the LAD and the second target branch in the left coronary artery (BITA group), while 249 patients (79.6%) had the ITA to LAD bypass and the SV graft to the second target branch in the left coronary artery (ITA/SV group). The mean follow-up period was 6.8+/-4.9 years. The cumulative patency rate of ITA-LAD bypasses at 10 years was 100% in the BITA group and 81.4% in the ITA/SV group. The ITA to LAD bypass was occluded in 14 (5.6%) patients of the ITA/SV group. In the ITA/SV group, the cumulative graft patency rate of the ITA to LAD bypass in patients who had severe (> or =76%) native coronary stenosis between the two anastomotic sites was 98.6% at 5 years, and was significantly higher than that of 82.3% in patients without severe stenosis (p<0.0001). Long-term patency of the ITA-LAD bypass was affected by the presence of the patent SV graft to the left coronary artery, particularly when the native coronary stenosis between the two anastomotic sites was not severe. Competitive flow from SV graft could play an important role in occlusion of the in-situ arterial graft.