[Sequential coronary artery bypass grafting using arterial conduits].

Fourty one patients underwent sequential coronary artery bypass grafting (CABG) using in situ arterial conduits as sequential bypass grafts. Included were sequential bypass from diagonal branch to left anterior descending artery (LAD) using the left internal thoracic artery (LITA) in 29 patients, skip bypass from segment 7 to segment 8 (AHA classification) of LAD using LITA in 5 patients and sequential bypass to the distal branches of the right coronary and circumflex arteries using the right gastroepiploic artery in 7 patients. There were no hospital deaths and only one patient who received skip bypass died of heart attack a couple of years after-operation. The overall patency rate was 95% (77/81). Reoperations were done in three patients all of whom received sequential bypass using LITA. It was characteristic that the distal anastomoses of sequential graft occluded in 7 of 9 patients and those proximal anastomoses were patent. This procedure is one available and reliable option for multiple coronary bypass grafting. However, if the arterial conduits are too small in caliber to use for sequential grafts, they should be used as individual grafts.