Utilization of Non-Reversed Saphenous Veins in Coronary Bypass Surgery
Robert Boova1, David DeFazio2, Christopher McAndrew1, Farhan Nadeem1, Mohammed Kashem1, Yoshiya Toyoda2
1Temple University Hospital, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA, 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
OBJECTIVE: Reversed saphenous vein is the most commonly used conduit in coronary artery bypass grafting (CABG). Use of non-reversed saphenous vein grafts (NRSVG) in CABG to avoid conduit-to-target mismatch has been previously described; though the technique is not widely utilized currently. The purpose of this study is to report outcomes in CABG in which the primary non-arterial conduit was NRSVG.
METHODS: After IRB approval, 427 patients undergoing CABG from March 2013-October 2019 were reviewed. Procedures included isolated CABG and CABG combined with other procedures. NRSVG were used to construct straight and sequential grafts, in conjunction with arterial grafts. All SVG were harvested endoscopically, cannulated proximally, and lysed with a standard vascular valvulotome. Routinely, grafts were evaluated by transit time flow measurement (TTFM) upon completion.
RESULTS: A total of 911 conduits - 509 arterial and 402 NRSVG - were used to construct 1,154 bypass grafts. There were 230 straight NRSVG constructed and 172 sequential NRSVG.
Mean flow by TTFM was 62.7 mL/min for all NRSVG, and 56.7 for all arterial grafts. Flows remained adequate across many other variables as described in Table 1.
There were no cardiac-related adverse outcomes attributable to vein graft failure, including early graft occlusion, in patients receiving NRSVG.
CONCLUSIONS: NRSVG is a useful conduit for CABG. TTFM values were sufficient and were not inferior to arterial graft flows. This technique avoids conduit-to-target mismatch and facilitates graft construction with the larger-diameter SVG segment anastomosed at the aorta, and the smaller SVG segment to the coronary artery.
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