Long-term conduit durability is important in coronary artery bypass grafting, particularly in off-pump coronary artery bypass grafting (OPCAB). A retrospective study presented at the AATS 2026 evaluated whether saphenous vein (SV) composite grafts based on the left internal thoracic artery (LITA) provide long-term graft patency comparable to total arterial composite grafting.

The analysis included 634 patients who underwent OPCAB using LITA-based composite grafts between 2006 and 2009. Among them, 215 patients received SV composite grafts as the second or third conduit (SV group), while 419 underwent total arterial composite grafting (TAC group). Fifteen-year graft patency and 18-year clinical outcomes were assessed using multivariable analyses and propensity score matching.

Findings

• Three-vessel disease was more frequent in the SV group than in the TAC group: 79.1% vs 69.7% (p=0.012).
• Operative mortality did not differ significantly between groups: 0.5% in the SV group vs 1.4% in the TAC group (p=0.432).
• Postoperative complication rates were comparable between grafting approaches.
• Fifteen-year patency of SV composite grafts was 91.8% (90 of 98 distal anastomoses), compared with 89.6% for arterial composite grafts (147 of 164 distal anastomoses; p=0.557).
• Ten- and 18-year overall survival rates were 69.4% and 42.2%, respectively, without significant between-group differences (p=0.372).
• Cumulative incidence of major adverse cardiac events was 27.1% at 10 years and 27.9% at 18 years, without significant between-group differences (p=0.158).
   

In this retrospective OPCAB cohort, SV composite grafts based on the in situ LITA demonstrated long-term graft patency and clinical outcomes comparable to those observed with total arterial composite grafting.