Abstract
Reverse saphenous vein homografts (RSVH) were needed in 16 patients during the past two years to offer a more thorough myocardial revascularization procedure since autogenous donor material was limited either because of previous surgeries or unuseable harvested conduits. All patients (11 men/5 women, mean age of 71.1 years) presented with severe coronary insufficiency. Nine patients were having reoperations after having previous successful operations (mean 6.9 years), and 2 were having third-time redo surgery about fifteen years after their initial procedures. RSVH were selected by ABO blood typing and were supported postoperatively by antiplatelet therapy. RSVH allowed additional bypass grafting in all patients and yielded an average of 4.1 grafts per patient. To minimize the operative risks, RSVH were mainly used for occluded targeted vessels or nondominant arteries. Three early deaths (less than thirty days) occurred from (1) progressive heart failure after emergent bypass and mitral valve repair for cardiogenic shock, (2) stroke after redo surgery, and (3) renal failure after urgent redo bypass. Although the mean follow-up was only 11.5 months, the remaining 13 patients have clinically improved. Five selected patients have been restudied with arteriography and have demonstrated successful revascularization, ie, patent internal mammary arteries (6/6) and autogenous venous grafts (5/5). However, 4/10 RSVH conduits were nonfunctional and the other 6 were patent.
RSVH are effective conduits for cardiovascular reconstruction with excellent immediate hemodynamic characteristics similar to those of autogenous veins. They have been extremely effective in patients with limited autogenous donor material and, in selected cases, when a quick source of bypass material is needed in an emergent fashion. While the initial patency rates have been acceptable, long-term follow-up is needed for comparative rates.
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