The 2010 ESC/EACTS guidelines on myocardial revascularization does not present suggestions about disease-free saphenous vein grafts at the time of redo coronary artery bypass grafting

Abstract

On August 2010, a task force of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) published the ESC/EACTS guidelines on myocardial revascularization. In a recent editorial, Taggart and colleagues emphasized that in contrast to previous guidelines for interventions in coronary artery disease produced independently by the cardiology and the cardiac surgery communities, the new one recognized the need for cohesive guidelines applicable to the management of the entire spectrum of coronary artery disease and suggested a multidisciplinary approach when recommending intervention [1]. Subsequently, the same authors presented another editorial advising how the ‘Heart Team’ should deal with some uncomfortable circumstances and/or disagreements, which are inherent to any new information, in order to ensure that the ESC/EACTS guidelines can be followed in the patient care practice [2]. Coincident with these two editorials, we are trying to prepare a conceptual text on coronary saphenous vein grafts (SVGs), specially focusing on replacement of angiographically disease-free grafts at the time of redo coronary artery bypass grafting (CABG). The replacement of old vein grafts at the time of redo operations is controversial. Routine replacement of all SVGs, which are beyond 5 years of age at the time of reoperation, despite their angiographic appearance, has been an accepted practice at many institutions [3]. Grondin wrote an important editorial with a more conservative view, discouraging the replacement of angiographically normal grafts after 5 years by another vein segment. Based on his own long-term follow-up data, which included angiography, he noted that although, in general, graft disease afflicts 75% of grafts during the first decade, there is a subgroup of