Factors influencing coronary artery bypass graft patency.

Coronary artery bypass surgery is one of the most frequently performed and successful operations in improving quality of life for patients with intractible angina. Unfortunately, there is accumulating evidence that angina will eventually return and consequently an increasing amount of repeat surgery is being undertaken. Subsequent operations have a reduced chance of benefit and many patients are only in early middle age at the time of initial surgery. It is obviously of paramount importance, therefore, to try and maintain graft patency for as long as possible. Various factors such as avoidance of certain surgical techniques, use of the internal mammary artery whenever possible, continued use of aspirin and attention to major risk factors are known to significantly influence graft patency. This review examines these factors in detail and provides practical advice on how to optimize long-term patency.