Do the Paths of Sequential Vein Grafts Influence the Outcomes of Coronary Artery Bypass Surgeries?


  • Yuan-Hsi Tseng Chia-Yi Chang Gung Memorial Hospital
  • Chih-Chen Kao
  • Chien-Chao Lin
  • Chien-Wei Chen
  • Ming-Shian Lu
  • Chu-Hsueh Lu
  • Yao-Kuang Huang



coronary artery bypass grafting;, coronary artery bypass surgery;, sequential vein graft;, great saphenous vein graft


Background: The use of a sequential vein graft (SVG) in coronary artery bypass grafting (CABG) in multi-vessel coronary disease is common. This study aimed to investigate the influence of the paths of SVGs on the outcomes of CABG.

Methods: From January 2011 to June 2017, 126 patients underwent elective isolated CABG. If the path of the SVG was from the aorta to the right coronary artery (RCA)/ posterior descending artery (PDA) to the left circumflex artery (LCX)/obtuse marginal artery (OM), the patients were included in Group R. If the path was from the aorta to the LCX/OM to the RCA/PDA, the patients were included in Group L. The in-hospital and follow-up outcomes were analyzed.

Results: Group R had 69 patients, and Group L had 57 patients. Univariate analysis showed that Group L had a higher number of grafts (P < .001) and less aortic cross-clamping time (P < .001) and total bypass time (P = .001). Otherwise, Group L had 14 patients (19.3%), who received first diagonal branch (D1) bypass grafting, while Group R had none (P < .001). In the multivariate analysis, in-
hospital mortality from heart failure, postoperative acute kidney injury, medium-term mortality, and readmission for cardiac incidents were not associated with the SVG path.

Conclusion: The SVG path from the aorta to the LCX/OM to the RCA/PDA facilitated the additional D1 bypass grafting, but the outcomes for this approach were not significantly different from those for the other path.


An K, Mei J, Zhu J, Tang M. Correlates of haemodynamic flow characteristics of sequential saphenous vein grafts in coronary artery bypass grafting. Interactive cardiovascular and thoracic surgery 2018.

Christenson, Md, PhD JT, Schmuziger, Md M. Sequential Venous Bypass Grafts: Results 10 Years Later. The Annals of thoracic surgery 1997;63:371-6.

Xiao F, Wang J, Wu H, Sun H. Sequential vein bypass grafting is not associated with an increase of either in-hospital or mid-term adverse events in off-pump coronary artery bypass grafting. Chinese medical journal 2015;128:63-8.

Kim HJ, Lee TY, Kim JB, et al. The impact of sequential versus single anastomoses on flow characteristics and mid-term patency of saphenous vein grafts in coronary bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2011;141:750-4.

Christenson JT, Simonet F, Schmuziger M. Sequential vein bypass grafting: tactics and long-term results. Cardiovascular surgery (London, England) 1998;6:389-97.

Li H, Xie B, Gu C, et al. Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow. BMC cardiovascular disorders 2014;14:65.

Sewell WH. Improved coronary vein graft patency rates with side-to-side anastomoses. The Annals of thoracic surgery 1974;17:538-44.

Tinica G, Chistol RO, Bulgaru Iliescu D, Furnica C. Long-term graft patency after coronary artery bypass grafting: Effects of surgical technique. Experimental and therapeutic medicine 2019;17:359-67.

Jeong DS, Kim YH, Lee YT, et al. Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery. The Annals of thoracic surgery 2013;96:778-85; discussion 85.

Ouzounian M, Hassan A, Yip AM, et al. The impact of sequential grafting on clinical outcomes following coronary artery bypass grafting. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2010;38:579-84.

Koyama S, Itatani K, Yamamoto T, et al. Optimal bypass graft design for left anterior descending and diagonal territory in multivessel coronary disease. Interactive cardiovascular and thoracic surgery 2014;19:406-13.

Nagendran J, Tarola C, Catrip J, et al. Is There a Role for Diagonal Coronary Artery Stenting in Patients Undergoing Robotic Coronary Artery Bypass Graft Surgery? Journal of clinical medicine research 2018;10:626-9.

Yajima S, Toda K, Nishi H, et al. Redo coronary bypass grafting for congenital left main coronary atresia: a case report. Journal of cardiothoracic surgery 2017;12:26.

Harskamp RE, Alexander JH, Schulte PJ, et al. Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial. JAMA surgery 2014;149:798-805.

Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Annals of surgery 2013;257:824-33.

Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation 2014;130:1445-51.

McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiology and therapy 2017;6:203-23.

Leuprecht A, Perktold K, Prosi M, Berk T, Trubel W, Schima H. Numerical study of hemodynamics and wall mechanics in distal end-to-side anastomoses of bypass grafts. Journal of biomechanics 2002;35:225-36.

Andreou AY. A case of dynamic segmental saphenous vein graft compression during diastole. Cor et Vasa 2016;58:e444-e7.

Chokshi SK, Meyers SN. Diastolic segmental compression of saphenous vein bypass graft. American heart journal 1989;118:402-4.

Christophides T, Georgiou G, Yiangou K. Angiographic segmental narrowing of a saphenous vein bypass graft during diastole. The Journal of invasive cardiology 2009;21:e101-2.

Bove T, Monaco F, Covello RD, Zangrillo A. Acute renal failure and cardiac surgery. HSR proceedings in intensive care & cardiovascular anesthesia 2009;1:13-21.

O'Neal JB, Shaw AD, Billings FTt. Acute kidney injury following cardiac surgery: current understanding and future directions. Critical care (London, England) 2016;20:187.

Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clinical journal of the American Society of Nephrology : CJASN 2006;1:19-32.



How to Cite

Tseng, Y.-H., Kao, C.-C., Lin, C.-C., Chen, C.-W., Lu, M.-S., Lu, C.-H., & Huang, Y.-K. (2020). Do the Paths of Sequential Vein Grafts Influence the Outcomes of Coronary Artery Bypass Surgeries?. The Heart Surgery Forum, 23(1), E001-E006.