Technique for the coronary snake graft operation.

The use of one end-to-side anastomosis with side-to-side technique for all additional vein-coronary anastomoses has given continually good results and has been used in 227 of 411 patients undergoing vein graft operations, including all multiple graftings done since April, 1972. The operative mortality was 4.6%. Arteriography by the end of the third postoperative month has been obtained in 98.4% of the 377 eligible patients. It showed that 98% of the 304 side-to-side anastomoses were patent, with 289 (95%) having unrestricted communication with the aorta. The proximal segment was widely patent in 193 (97%) of the 200 patients with snake grafts having postoperative arteriography. The distal end-to-side anastomosis was patent in 176 (88%) of these 200 patients. The average was 2.3 unrestricted grafts per patient. These results are better than the patency rates of 89 and 87% obtained previously with single and Y-grafts, respectively. Technical details have been worked out for construction of suture lines, choosing the correct length for segments, obtaining a reliable proximal segment, routing grafts to multiple coronary branches, and removing air from the grafts.