Approach to the Patient with Prior Bypass Surgery

Nguyen, Thach; Pham, Loan T.; Cheem, Tan Huay; Douglas, John S.; Hermiller, James; Grines, Cindy L.

doi:10.1111/j.1540-8183.2004.04033.x

Cited by 10 publications

(5 citation statements)

References 29 publications

(28 reference statements)

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“…PCI to a native coronary artery has traditionally been recommended in prior CABG patients, because SVG PCI carries higher procedural risk and higher restenosis rates compared to native coronary PCI (31,32). Current data was based on the general patients; however, the data focused on diabetic patients was scarce.…”

Section: Patients Undergoing Bypass Graft Interventions Had Higher In-stent Restenosis (mentioning

confidence: 99%

Long-term outcomes of percutaneous coronary intervention in grafts and native vessels in coronary artery bypass grafting patients with diabetes mellitus

et al. 2019

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Background: Atherosclerosis in diabetic patients progresses fast. Evidence on how to choose target vessels of percutaneous coronary interventions (PCIs) in diabetic patients post-coronary artery bypass graft (post-CABG) is insufficient.Methods: One hundred and fifty-seven patients with diabetes and previous CABG, who underwent PCI of either a graft vessel (GV) (n=44) or a native vessel (NV) (n=113) in the National Center for Cardiovascular Disease, China, were studied. In-hospital and long-term clinical outcomes were compared between the groups. Results: Diabetic patients with prior CABG had more PCI to native arteries, but the proportion of grafts PCI increased as time went on. Both groups had similar baseline characteristics. Group GV patients compared with group NV had more totally occluded NVs, less totally occluded grafts and more in-stent restenosis. However, there was no difference in in-hospital mortality and long-term incidence of major adverse cardiac event (MACE), cardiac death, nonfatal myocardial infarction (MI), or revascularization. Multivariate logistic regression analysis showed that PCI success [hazard ratio (HR), 11.488; 95% confidence interval (CI), 1.135-116.303; P<0.05] was independent predictor of MACE. Conclusions: It suggested similar long-term clinical outcomes after PCI in GV or NV in prior CABG patients with diabetes. Thus, the vessel with higher estimated PCI success rate should be prioritized by operators.

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Section: Patients Undergoing Bypass Graft Interventions Had Higher In-stent Restenosis (mentioning

confidence: 99%

Long-term outcomes of percutaneous coronary intervention in grafts and native vessels in coronary artery bypass grafting patients with diabetes mellitus

et al. 2019

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“…The atherosclerotic plaque of vein graft is diffuse, concentric, and friable, characterized by foam cells and inflammatory cells in abundance, poorly developed/absent fibrous cap, and little calcification. [7][8][9] This nature of the plaque is responsible for the distal embolization resulting in no reflow after PCI. No reflow is associated with worse clinical outcomes including high postprocedural MI (17.7% versus 3.5%) and death (7.4% versus 2%).…”

Section: Discussionmentioning

confidence: 99%

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions

2018

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Distal embolization is the detrimental factor in SVG intervention. There is no specific treatment for it except prevention. Guidelines have endorsed the use of embolic protection devices; however, their use is not without complications, and increases the procedural time and cost for the patient. The objective of this study is to analyze the procedural results and immediate outcome in de novo SVG stenting. A retrospective observational study of patients who have undergone SVG-percutaneous coronary intervention at our institute. Baseline clinical, demographic data, intervention details, and in-hospital events are analyzed. Statistical analysis was done using Mini tab version 17. Chi-square testing, odds ratio, and 95% confidence intervals were calculated. The study population included 96 lesions in 80 patients. Average age of the graft was 8.2 ± 4 years. Embolic protection devices were used only in 10%. Angiographic and clinical success was seen in 92.5%. Distal embolization was seen in 7.5%. Drug-eluting stent and shorter stents were associated with lesser distal embolization. Stent length (> 20 mm) proved to be an independent predictor of distal embolization. There was no correlation between distal embolization and age of patient, sex, hypertension, diabetes, and smoking, left ventricular function, age of graft, direct stenting, use of embolic device, and glycoprotein 2b/3a inhibitors. De novo SVG lesions can be stented with a high rate of angiographic and procedural success. Stent length is the only independent predictor of distal embolization. SVG interventions can be safely done in the absence of embolic protection devices irrespective of the graft age.

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“…Other causes are incomplete surgical revascularisation (10%), kinked grafts, stenosis at the proximal or distal anastomotic sites, focal stenosis distal to the insertion site, inaccessible intramyocardial position of a recipient artery, or bypass of wrong vessel 2 4. Patients undergoing minimally invasive and off-pump techniques, and those receiving non-IMA grafts, have high risk of early postoperative ischaemia 5.…”

Section: Early Postoperative Periodmentioning

confidence: 99%

“…Immediate access to a covered stent is warranted should suture-line perforation occur. Recurrent ischaemia between 1 month and 1 year after CABG is mostly due to peri-anastomotic stenosis, graft occlusion, or mid-SVG stenosis from intimal hyperplasia 2. Stenosis of distal anastomosis of SVG or arterial grafts can be successfully dilated with balloon angioplasty as that of middle or distal portion of IMA or radial graft.…”

Section: Early Postoperative Periodmentioning

confidence: 99%

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An update on coronary bypass graft intervention

Dash

2014

Heart Asia

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Coronary artery bypass grafting (CABG) remains one of the most common surgical procedures. In spite of great advancements like arterial grafts and off-pump bypass procedure, recurrent ischaemia may ensue with the lesions of the graft. Early postoperative ischaemia (<30 days) is due to graft occlusion or stenosis, and percutaneous coronary intervention (PCI) is frequently feasible. Late postoperative ischaemia (>3 years) is most often due to a saphenous vein graft (SVG) lesion. Multiple diseased grafts, reduced left ventricular function, and available arterial conduits favour repeat CABG, whereas, a patent left internal mammary artery to left anterior descending favours PCI. Embolic protection reduces atheroembolic myocardial infarction during PCI of SVG and should be routinely used in treatment of SVG lesions. A variety of vasodilators may reduce the risk of or mitigate the consequences of noreflow. Drug-eluting stents reduce restenosis in SVG grafts, and have become the default strategy for many interventionalists.

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Approach to the Patient with Prior Bypass Surgery

Cited by 10 publications

References 29 publications

Long-term outcomes of percutaneous coronary intervention in grafts and native vessels in coronary artery bypass grafting patients with diabetes mellitus

Long-term outcomes of percutaneous coronary intervention in grafts and native vessels in coronary artery bypass grafting patients with diabetes mellitus

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions

An update on coronary bypass graft intervention

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