Comparison of long-term patency of “horseshoe” saphenous vein grafts with and without valves

OBJECTIVE: The paper analyzes the long-term patency of valveless and valvular limbs of reversed saphenous veins. METHODS: Between 1983 and 1988, 335 patients underwent isolated coronary artery bypass grafting (CABG) with 1,329 grafts. Eighty-three patients had follow-up angiography over 8-12 years. The side-to-side saphenous vein to aortic "horseshoe" anastomosis was created just before the first valve from the ankle (naturally a valveless portion). The valveless (ankle end) was depicted in every case. These patients with angiography were similar to 252 patients without angiography in terms of age, gender, number of grafts, diseases vessels, single (A) and sequential (B) grafts and actuarial survival. In the 83 patients, graft patency was 75%. Overall patency was the same in B versus A grafts (76% versus 74.6%); valveless patency (78.7%) was slightly better than valvular patency (73.3%). RESULTS: In patients with B grafts (88.6%) valveless patency was significantly better than valvular patency (71.9%) (P < 0.02). The patency of B-valveless to the left coronary bed was also better, (86.8% versus B-valvular 70.5%, P < 0.04). Attrition of the B-valveless and B-valvular grafts was similar up to 8 years, but by the 12th year it had become significantly different (P < 0.05). The 12-year actuarial survival rate of the patients was 87.7%. CONCLUSIONS: We recommended the use of valveless vein segments when possible.