One year patency of valvulotomised vein grafts is similar to that of arterial grafts

Objectives: Inferior vein graft patency is attributed to various factors. Venous valves may limit flow, cause thrombus formation and diminish diastolic backflow. Scarce literature indicates superior patency rates after valvulotomy. We aimed to compare midterm patency rate of valvulotomised vein grafts and arterial grafts clinically and by computertomography (CT-scan) of the heart in patients undergoing coronary artery bypass grafting (CABG) .

Methods: Between November 2007 and January 2010, valvulotomised saphenous vein grafts were used in 147 patients undergoing CABG with 2.8±1 arterial and 1.5±0.6 venous anastomoses (mean). In 12 patients intraoperative bypass flow rate was measured before and after valvulotomy of the venous bypass graft to the right coronary artery (RCA). Patients were followed clinically for at least one year. 45 patients with unclear chest pain underwent CT-scan.

Results: 100 patients underwent isolated CABG and 47 had additional procedures like single valve procedure (16), multiple valve surgery (8), ventricular remodelling (12) or cryoablation (8). 30 day mortality was 2%, 3/147. The intraoperative flow measurements showed significantly increase (p=0.01) of the flow rate of the venous bypass graft to the RCA after valvulotomy (+20.2ml/min mean).

Patients were followed by letter or phone call. 96% were in CCS (Canadian-Cardiovascular-Society) classification 0 and 4% in CCS I. Late mortality was 2% (two patients died of pancreas carcinoma, in one patient the cause of death was unknown). One patient underwent percutaneous coronary intervention because of angina pectoris, fortunately the angiography showed well open bypass grafts and no de novo stenosis of the coronary arteries. Another had suspected myocardial infarction; in his case the angiography revealed a de novo stenosis of the Ramus posterolateralis sinister 2 (RPLS2) that was stented. In 45 patients a CT-scan of the heart was performed: The patency rate of valvulotomised saphenous vein grafts was 97.8% versus 95.6% in arterial grafts after 18±6 month postoperatively.

Conclusions: Valvulotomised venous grafts had the same one year patency rate as arterial grafts and might thus be an alternative to extended t-grafting with limited functional patency rates for the most distal territory.