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Ann Thorac Surg 1976;21:12-15
© 1976 The Society of Thoracic Surgeons

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Articles

Improvement in Forward Coronary Blood Flow by Using a Reversed Saphenous Vein with a Competent Valve

Division of Cardiopulmonary Surgery, University of Oregon Health Sciences Center, Portland, OR, and Mercy Hospital, Des Moines, IA

Accepted for publication June 13, 1975.

^* Address reprint requests to Dr. Okies, University of Oregon Health Sciences Center, Portland, OR 97201

Reversed segments of saphenous vein have been the grafts of choice for aortocoronary bypass (ACB). Internal mammary arteries and free radial autografts have recently been shown to have a higher patency rate, but flow is usually lower. Normally forward coronary blood flow ceases and retrograde flow occurs during cardiac systole. Prevention of retrograde flow with a rapidly acting valve proximal to the coronary artery anastomosis should improve forward coronary blood flow.

Thirty-nine reversed saphenous veins containing a competent valve were implanted in 32 patients undergoing ACB. After accurate zero flow was determined and a resting state achieved, mean (22 veins) and pulsatile (17 veins) flows were measured distal to the valve with the valve competent and temporarily incompetent. A competent valve in 10 right coronary artery vein grafts increased mean flow by 29.7% (+41 ml/min; p < 0.005) and pulsatile flow in 6 veins by 17.7% (p < 0.001). A competent valve in 12 left coronary artery vein grafts increased mean flow by 31.3% (+34 ml/min; p < 0.01) and pulsatile flow in 11 veins by 13.7% (p < 0.001).

This study suggests that a portion of reversed saphenous vein containing a competent valve provides greater coronary artery blood flow than veins without valves and may be the conduit of choice for coronary artery revascularization.

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