Anaortic Coronary Artery Bypass Grafting With and Without Saphenous Vein: 20-Year Clinical Results

Although the benefit of off-pump coronary artery bypass grafting (CABG) has been questioned, its main advantage is the reduction in perioperative cerebrovascular accidents due to the lack of manipulation of the ascending aorta (anaortic CABG). This procedure is generally performed using only arterial conduits (ACs), as saphenous vein grafts (SVGs) are usually proximally anastomosed to the ascending aorta. Additionally, avoiding the use of SVGs can be beneficial, as they have the highest attrition rate among available conduits. However, the 10-year patency rates of SVG and right internal thoracic artery (RITA), when connected as a Y-graft to the left internal thoracic artery (LITA), are similar.1,2 Moreover, SVGs grafted to the right coronary system show better patency rates and clinical outcomes when proximally anastomosed as an I-graft to the RITA rather than to the ascending aorta.3 We combined the benefits of both strategies by adding one or more SVGs proximally anastomosed to one or both ITAs in anaortic CABG.