Background The quality of saphenous vein grafts (SVG) frequently is cited by surgeons as a determinant of coronary artery bypass graft (CABG) outcomes, but this relationship has not been investigated formally.
Methods Detailed clinical data were collected at 27 Midwestern academic and community medical centers on all patients who underwent CABG surgery in 1999 and 2000. The quality of SVG was assessed on a subjective 5-point scale from excellent to poor. Patients were divided into two groups based on SVG quality: 7,476 with excellent, very good or good veins, and 1,465 with fair or poor veins. Stepwise logistic and linear regressions were performed to derive risk-adjustment equations for inpatient mortality (12 pre-operative variables, c-statistic 0.829) and post-op length of stay (LOS) for uncomplicated cases (18 pre-operative variables, r2=0.288). The effects of introducing variables describing SVG quality and perfusion times into these equations were evaluated. The relation of high quality and low quality veins to 12 post-op outcomes was examined.
Results Low SVG quality was associated with significantly increased mortality (OR=1.573, p<0.007) and LOS (p<0.001). The effect of low quality SVG on mortality was similar to that associated with female gender and with a history of stroke. Longer perfusion times also were associated with poor outcomes but did not affect the magnitude or significance of the effect of SVG quality. Women were more likely than men to have low SVG quality (22% vs. 14%, p<0.001), but the effect of low SVG quality on outcomes was similar in women and men. Low SVG quality was associated with higher rates of graft occlusion and infarction (p<0.001), cardiac arrest (p<0.007), pump failure (p<0.001), new mechanical circulatory assistance (p<0.002), and post-op transfusions (p<0.001).
Conclusions Low quality SVG are associated with significantly poorer CABG outcomes including higher inpatient mortality and routine post-op LOS, even after adjusting for perfusion times and pre-op risk factors. Increased risk-adjusted mortality may be secondary to graft occlusion, pump failure and post-op hemorrhage. Whenever possible, alternatives to low quality SVG should be sought.
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