Article

Techniques in coronary artery grafting

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Abstract

Between January 1971 and August 1977 we operated on 1775 patients for ischemic heart disease. Since 1976 the mortality rate in pure revascularization surgery decreased to 2.1%, although we placed a considerably higher number of distal anastomoses than previously.

Inclusion of small arteries, and such as multiple diagonal and posterolateral branches, has not been accompanied by an increase in perioperative infarction rate by electrocardiographic criteria (about 5% in the total series).

In reviewing all data recently, it appears that 57 (3.2%) late deaths have occurred. The 1332 patients who were followed for 1 to 6.5 years were divided into three subgroups having (A) normal or moderately impaired left ventricular contractions, (B) left ventricular aneurysms, and (C) generalized poor left ventricular contractions. Survival curves for various subgroups are presented in the Figure. Cases with impending (recurring) infarctions or combined procedures, other than aneurysmectomies, were excluded. Late mortality in patients with single grafts was mainly due to noncardiac causes (6 of 7 cases).

Techniques

Since 1971 for distal anastomosis we have used a suspended running suture technique with 6-0 Prolene, starting at the base of the arteriotomy,1 often called “parachute-technique.” A similar technique was used for transverse, longitudinal or diamond shape side-to-side graft-coronary anastomoses. A running 5-0 Prolene suture has been used for the aortic anastomosis, using a nasal septal punch for making the aortic hole since 1973. We have used the lower leg veins when suitable, taking care to use sufficiently large veins (≤3.5 mm internal diameter) if side-to-side anastomoses are . . .


 

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