Optimiza？？o da perviabilidade do enxerto venoso na revasculariza？？o miocárdica: compreens？o da fisiopatologia, novas drogas e avan？os técnicos

background: this study analyzes the experience of 3116 cases of coronary artery by-pass grafting revascularization of our group and define the percentage of early and late patency of the venous grafts. we also look this issue under the new concepts of endothelial reaction, influence of various drugs and improvement of surgical techniques. material and methods: from september 1971 until august 1998, 3116 cases of myocardial revascularization with cardiopulmonary by-pass were operated in our service. the surgical procedures were analyzed separately regarding the type of grafts used in each case; exclusively venous grafts, exclusively arterial grafts and venous and combined arterial grafts . we also made the analysis in three different periods, 1971-80, 1981-90 and 1991-98. the incidence of reoperation was analyzed trying to identify the patency of the different types of grafts and their results. results: the age of the patients varied from 22 to 85, with a mean of 52.4 years, male sex was predominant with 68.4%. the mortality varied from 1.7% for vein grafts revascularization to 15.8% when associated complex procedures were done. of the 3116 patients, 255 were reoperated, being 3.8% with isolated internal thoracic artery and 8.1 % isolated vein graft. conclusions: a) the immediate result of vein grafts patency was dependent upon the surgical handling during vein harvesting and preparations, care during anastomosis and quality of coronary arteries. b) the late results in the 5th and 10th year were influenced by the spectrum of the arteriosclerosis. c) patients with vein grafts represent the majority of reoperations when compared with those who received arterial grafts. d) there is a possibility of increasing vein grafts patency by a better handling of the graft, use of drugs such as calcium blockers, papaverin, aprotinin, nitrates and the prophylaxis of arteriosclerosis.