Ann Thorac Surg 2000;70:1708
© 2000 The Society of Thoracic Surgeons
Invited commentary
Invited commentary
W. Gerald Rainer, MDa
a Department of Surgery, University of Colorado, Health Sciences Center, 2005 Franklin St, Suite 380, Denver, CO, 80205-5476 USA,
e-mail: wrainersjh828{at}pol.net
Invited commentary
The varying long-term quality of saphenous vein conduits used as coronary bypass grafts has always been enigmatic. Why do some vein grafts show signs of deterioration in a relatively short time and others (such as those in the 2 cases reported by Suda and colleagues) look pristine angiographically after an incredibly long time span of 22 years? These observations are provocative and force us to attempt to analyze some of the variables concerned in coronary artery bypass surgery. Certainly many factors, some obvious and some unknown, must be at play.
Factors that bear upon quality and longevity include technique of harvesting, handling and precision of implantation, use of crystalloid or blood as dilating fluids (with or without vasodilators), and amount of pressure used in distention. Host considerations include type and degree of native coronary disease, adequacy of run-off of the coronary bed, and probably ethnic factors that, as a rule, involve dietary habits, predisposition to metabolic disorders, and the like. Medical management (or patient compliance) of dietary lipids and other potentially deleterious substances may have an influence on long-term quality of conduits.
Regardless, the authors have shown with beautifully convincing angiograms, taken at 22 years postoperatively, that meticulous attention to factors that we can control may pay satisfying dividends in the long run. At least, in these 2 cases reported here, they certainly did some things right.
Related Article
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Twenty-two-year follow-up of saphenous vein grafts in pediatric Kawasaki disease
- Yuji Suda, Yasuo Takeuchi, Tetsuo Ban, Seiichi Ichikawa, and Ryuji Higashita
Ann. Thorac. Surg. 2000 70: 1706-1708.
[Abstract]
[Full Text]
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