SAPHENOUS VEIN GRAFT PATENCY ON DACRON CONDUITS IS COMPARABLE TO PROXIMAL ANASTOMOSIS CONSTRUCTED ON THE NATIVE AORTA: RESULTS OF A LONGITUDINAL COHORT OF PATIENTS WITH ASCENDING AORTIC REPLACEMENT AND CORONARY ARTERY BYPASS GRAFTS

Abstract

Coronary artery bypass grafts (CABG) is a well-accepted technique for coronary artery revascularization. Early saphenous vein graft (SVG) failure is reported between 10-20% at one year. However, patency of SVG anastomosed on an ascending aortic Dacron graft remains debated. The purpose of this study is to provide insight on the patency rate of SVG anastomosed on a Dacron graft. We reviewed data on all consecutive adult patients who underwent an ascending aortic replacement with concomitant CABG between 2007 and 2018 and follow-up in a high volume aortic clinic. Operative reports, follow-up enhanced chest computed tomography (CT), and coronary angiograms were reviewed. Primary end-point was SVG patency within one year of CABG. One hundred and seven patients met inclusion criteria (mean age: 66.7±8.0 yo, 10% female, average EuroScore II 7.1±5.6). A total of 171 SVG (159 anastomosis on the dacron graft and 12 veno-venous anastomosis) were evaluated. Concomitant interventions to CABG were aortic valve replacement n=53, Bentall procedure n=22, aortic valve resuspension n=10, valve sparing n=2, total arch replacement n=36, and hemiarch replacement n=13. Ten patients (9%) had one or more SVG occluded. Of the 171 SVG, twelve (7%) SVG were occluded. Among the occluded grafts, 6/12 were on the 67 right coronary artery grafts (9.0% occlusion rate), 4 were on the 64 circumflex grafts (6.3% occlusion rate), 2 on the 40 LAD/diagonal grafts (occlusion rate 4.8%); p=ns between different territories. Only one of the 12 veno-venous grafts was occluded. Overall, occlusion rate of SVG anastomosed on the dacron was 6.9% (11/159). On review of surgical reports, occluded grafts were described as a suboptimal conduit in one patient and a poor vessel quality in 3 other patients. SVG anastomosed on Dacron conduits appear to have a comparable early patency rate (93%) to SVG anastomosed to the native aorta. Considering the good patency of SVG on Dacron grafts, use of veno-venous proximal anastomosis should be limited.