Equivalency of Saphenous Vein and Arterial Composite Grafts: 5-Year Angiography and Midterm Clinical Follow-Up.

BACKGROUND: We compared 5-year graft patency rates and midterm clinical outcomes of saphenous vein (SV) composite grafts with those of total arterial (TA) composite grafts in patients who underwent off-pump coronary artery bypass graft surgery (OPCAB).

METHODS: Three hundred sixty-three patients who underwent OPCAB using composite grafts based on the left internal thoracic artery were studied. The SV was used as a second (connected to the left internal thoracic artery) or a third (connected to the second arterial graft) composite graft in 90 patients (SV group); TA composite grafting was performed in 273 patients (TA group). Follow-up was complete in 96.4% of patients (350 of 363), with a median follow-up of 82 months. Five-year graft patency rates and long-term clinical outcomes were compared. A propensity score-matched analysis was also performed to minimize differences in preoperative and intraoperative variables (n = 69 in each group).

RESULTS: There were no differences in operative mortality and postoperative complications between the SV group and TA group. Actuarial 5-year patency rates of the venous and arterial composite grafts were 89.3% and 89.5%, respectively (p = 0.958). Those were also similar between the two propensity score-matched SV and TA groups (90.5% and 89.3%, respectively; p = 0.759). Five-year overall survival and freedom from major adverse cardiac and cerebrovascular events were 88.5% and 85.6%, respectively. Those were similar between the two groups before and after propensity score matching.

CONCLUSIONS: The SV composite grafts were equivalent to arterial composite grafts in terms of 5-year graft patency rates and midterm clinical outcomes.