20-YEAR FOLLOW-UP OF SAPHENOUS-VEIN AORTOCORONARY ARTERY BYPASS-GRAFTING

The clinical records of our first 100 patients to undergo saphenous vein aortocoronary bypass grafting were reviewed. The procedures were performed between March 19, 1970, and March 30, 1972. The patient population included 84 men, and the mean age was 51.4 years. There were 12 patients with single-vessel disease, 36 with double-vessel disease, and 52 with triple-vessel disease, for an average of 2.4 involved vessels per patient. Forty-eight patients were judged to have diffuse atherosclerotic disease. Twelve patients had left main coronary artery stenoses. Each patient received an average of 1.8 saphenous vein grafts. Thirty-six patients underwent repeat coronary artery bypass grafting after an average of 132.8 months and received an average of 3.5 grafts. This resulted in cumulative reoperative rates of 5%, 14%, 27%, and 36% at 5, 10, 15, and 20 years, respectively. The 5-, 10-, 15-, and 20-year survival rates were 89.8%, 68.4%, 53.1%, and 40.8%, respectively. Survival was not significantly related to the cause of death, cardiac-related causes being predominant. There were no significant relationships between the length of survival and sex, the number of grafts received, or the presence of left main stenosis. Survival was inversely related to age at initial operation (p = 0.046) as well as initial left ventricular end-diastolic pressure (p = 0.033). Survival positively correlated with the occurrence of triple-vessel disease (p = 0.031) and the presence of diffuse disease (p = 0.0077). Survival correlated with the occurrence of repeat grafting (p = 0.0079), the interval to repeat grafting (p = 0.0001), and survival after repeat grafting (p = 0.030), but again did not correlate with the operation received. The 5- and 10-year survival rates for repeat operation were 77.4% and 71.0%, respectively. Saphenous vein coronary artery bypass grafting in this era yielded a 41% 20-year survival. Cardiac-related events continued to account for the majority of all late deaths. Thirty-six percent of all patients and 53% of all long-term survivors underwent repeat operation. Repeat operation significantly influenced long-term survival.