Assessment of Graft Patency Between Pedicled Saphenous Vein and Conventional Saphenous Vein Conduits for Coronary Artery Bypass Surgery

Abstract

Introduction: The long-term successes of coronary artery bypass graft surgery depends on continued patency of the bypass conduits. After coronary artery bypass graft, however, the saphenous vein grafts show a high incidence of accelerated atherosclerosis. A major contributing factor to the early atherosclerotic process is damage to the vessel wall, especially endothelial injury that occurs during the conventional harvesting of the vein, using high- pressure distension. A new pedicled saphenous vein technique, the saphenous vein is harvested with its pedicled of surrounding tissue, preserves the entire vein wall including the vasa vasorum.

Objective: To determine the patency rate in between pedicled saphenous vein and Conventional saphenous vein by coronary computed tomography angiogram.

Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh. The period of study was from January, 2019 to September, 2020 and purposive sampling method was applied for this study. The study population was 80, with two groups having 40 patients each. Grouping of patients were done by purposive sampling method and all patients underwent elective coronary artery bypass graft in 2015. These group of patients again investigated through coronary computed tomography angiogram in 2020 for evaluation of saphenous vein patency and occlusion rate. Data was collected by using a standardized semi- structured questionnaire, face to face interview and hospital records.

Results: After five years postoperative follow up through the coronary computed tomography angiographic assessment showed 91.92% patency rate of pedicled saphenous vein grafts compared to 85.56% patency rate of conventional saphenous vein grafts. Similarly, the proportion of study saphenous vein grafts with total occlusion were higher in conventional saphenous vein grafts than pedicled saphenous vein grafts, but that was not statistically significant [Group A: 08 venous grafts occluded out of 99 venous grafts (8.08%); Group B: 13 venous grafts occluded out of 90 venous grafts (14.44%), p= 0.209].

Conclusion: This study was concluded that, pedicled saphenous vein has higher patency rate than conventional vein. It has also significantly slower progression of occlusion in pedicled vein grafts.