COMPARATIVE LONG-TERM RESULTS OF PATENCY OF SAPHENOUS VEIN GRAFTS AND LEFT INTERNAL MAMMARY ARTERY IN THE LEFT ANTERIOR DESCENDING ARTERY DURING CORONARY ARTERY BYPASS GRAFTING ON A «BEATING HEART»

Relevance. The long-term success of coronary artery bypass grafting is largely determined by the late patency of bypass grafts. Among all conduits, the left internal mammary artery consistently shows the best outcomes. However, most comparative studies are based on heterogeneous institutional experiences and include both on-pump and off-pump techniques. There is a lack of large-scale, single-surgeon series comparing long-term patency of mammary and autologous vein grafts to the anterior interventricular artery using a uniform off-pump sternotomy approach.

Aim. To compare, by means of control graft angiography, the long-term patency of autologous vein aortocoronary bypasses and mammary artery bypasses to the anterior interventricular artery following off-pump coronary surgery through a median sternotomy, all performed by one surgeon.

Materials and Methods. Between September 1997 and December 2024, 7422 off-pump coronary bypass operations were performed in the department. From May 2001 onward, 6829 of these (92 %) were carried out via median sternotomy. Control angiography was undertaken in 1059 patients (15.5 %). For the present analysis, we selected 843 patients operated on by a single surgeon. Among them, 652 received an autologous vein aortocoronary graft to the anterior interventricular artery, and 191 received a mammary artery graft to the same vessel.

Results. The patency rates for mammary artery grafts at 5, 10, and 15 years were 91 %, 77 %, and 56 %, respectively, versus 88 %, 70 %, and 41 % for vein grafts. These differences were not statistically significant (p = 0.09).

Conclusion. In off-pump coronary bypass grafting to the anterior interventricular artery via sternotomy performed by a single surgeon, the long-term patency of autologous vein grafts may be comparable to that of mammary artery grafts.

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