Improvement of postoperative graft patency rate for coronary revascularization.

For coronary artery revascularization, the long term patency rate of internal thoracic artery (ITA) is excellent and arterial conduit for coronary bypass grafting (CABG) has been actively pursued. Application of the right gastroepiploic artery (GEA) is on the increase but, the patency of the GEA graft is more technically demanding than that of ITA. To improve early postoperative graft patency for coronary artery bypass grafting (CABG) for arterial graft, we modified the technique for anastomosis and demonstrated the patency by postoperative angiogram in 26 consecutive patients receiving CABG. The graft was anastomosed to the coronary artery using two 8-0. Prolene sutures for arterial graft and 7-0 Prolene sutures for saphenous vein (SV) graft. The heal and toe sides of the graft were sutured separately by the parachute technique (double parachute technique), followed by running suturing and typing at bilateral sides. The number of distal anastomoses was 3.4/patient and 44 arterial grafts and 40 SV grafts were used for coronary revascularization. Arterial grafts consisted of 33 ITAs, 9 GEAs, and two inferior epigastric arteries. The angiograms taken 10 to 14 days after operation demonstrated 100% patency rate of arterial grafts and 39 out of 40 SV grafts were patent. The overall patency rate in the early postoperative period was 98.8% The "double parachute" technique for CABG is highly accurate anastomosis with good visualization and the patency rates for all kinds of grafts were found to have improved.