North American experience with the Perma-Flow prosthetic coronary graft.

Background: The Perma-Flow prosthetic coronary graft is a 5-mm polytetrafluoroethylene tube into which is incorporated a Venturi flow restrictor. An aorto-superior vena caval fistula is created and coronary anastomoses are constructed proximal to the resistor in side-to-side fashion, where arterial pressure is maintained. From November 1992 through December 1995, eight investigational centers in North America have implanted this graft in 40 patients with inadequate autologous alternatives.

Methods: Patients were selected for inclusion in this study if coronary artery bypass grafting was required and adequate autologous conduit to complete revascularization was not available. Operative data were completed by the implantating surgeon and referred to a central center, the Minneapolis Heart Institute, for correlation. Follow-up was conducted by data coordinators at each institution, and follow-up data were obtained directly from these coordinators for inclusion in the study.

Results: Patient age ranged from 53 to 82 years, and 15 patients were undergoing reoperations (38%). On each Perma-Flow graft one to four coronary side-to-side anastomoses were constructed. In addition, left internal mammary artery (n = 26), greater saphenous vein (8), right internal mammary artery (4), and gastroepiploic artery (4) were used to complete revascularization. Aortic (2) or mitral valve replacement (1) was also carried out. There were seven operative deaths (18%) and two late deaths (4 and 6 months). After 1 to 37 months (mean, 13 +/- 9 months) of follow-up, 29 of 31 surviving patients are asymptomatic. Echocardiographic heart size has not increased from the postoperative value, indicating limited volume load has not affected heart size. Protocol catheterization (n = 32) in 28 patients 1 week to 1 year postoperatively revealed 7 of 73 studied coronary anastomoses (9.5%) and two distal extensions and resistors were occluded (7%). In 1 patient during sternal debridement at 1 year, no flow was found in the graft.

Conclusions: The Perma-Flow graft is a useful adjunct to complete revascularization in patients with deficient autologous conduit.