Jt. Christenson et M. Schmuziger, HOW SERIOUS IS A PROXIMAL OCCLUSION OF A POSTEROLATERAL SEQUENTIAL BYPASS, Texas Heart Institute journal, 23(3), 1996, pp. 201-206
The sequential coronary bypass, despite having several demonstrated be
nefits, has been criticized for being solely dependent upon 1 proximal
anastomosis. The aim of this study was to evaluate the danger of a pr
oximal occlusion of a posterolateral sequential bypass graft. Between
1 January 1984 and 31 December 1994, 3,203 patients underwent primary
coronary artery bypass grafting with at least 1 sequential vein bypass
graft (780 patients received 1 sequential graft and 2,423 patients re
ceived 2). There were 5,626 sequential bypass grafts: 3,492 posterolat
eral (62%) and 2,134 antero-latero-septal (38%) grafts. There were 73
hospital deaths (2.3%). Follow-up was performed on 3,130 hospital surv
ivors (5,504 grafts), for an average of 59 +/- 36 months (range, 1 to
11 years). During follow-up, a total of 250 symptomatic sequential gra
ft occlusions occurred in 250 patients (8.0%). Only 23 (0.7%) of the s
urviving 3,431 posterolateral sequential bypass grafts had symptomatic
proximal occlusion, 35.9 +/- 5.9 months postoperatively, with all the
distal anastomoses remaining patent. Twenty-two of the patients so af
fected presented with angina and 1 with myocardial infarction. There w
as no mortality in 12 patients (52%), medical treatment was sufficient
, while 11 patients (48%) underwent successful repeat coronary revascu
larization. The operation consisted of a simple vein graft from the ao
rta to the distally patent sequential graft in all patients. Four pati
ents had additional coronary artery bypass grafting due to progression
of the disease. The 10-year survival rate was 86.7%. Symptomatic occl
usion of only the proximal segment of posterolateral sequential bypass
grafts occurs rarely and has a low risk of myocardial infarction and
mortality provided ?hat ?he terminal anastomosis is with a high-flow v
essel.