Multiarterial coronary artery bypass grafting with special reference to small vessel disease and results in women

Abstract

From 1985 to 1991 a total of 220 patients underwent coronary artery bypass grafting (CABG) with at least two native pedicled artery grafts. Bilateral internal mammary artery (IMA) grafting was performed in 201 patients, IMA combined with gastro-epiploic artery (GEA) grafting in five, and double IMA plus GEA grafting in 14; in addition 156 patients received 1-3 vein grafts. The primary indication for elective multi-arterial CABG was coronary arteries of small calibre (small vessel disease) in 77 patients, repeat CABG in 17 (without small vessel disease), varicose/stripped saphenous veins in 57 (without small vessel disease), while the remaining 69 were routine cases; the distribution differed between women (42, 0, 47, and 11%, respectively) and men (33, 10, 19, and 38%, respectively; P < 0.0001). The women also were older (62 +/- 7 vs 56 +/- 9 years; P < 0.001), and had higher prevalences of systemic hypertension, diabetes mellitus, and hypercholesterolaemia. The number of artery grafts and total number of grafts were, however, similar for women and men. Early mortality (< or = 30 days) was 5.6% in women and 2.4% in men (ns). Early mortalities in relation to primary indications were: 7.8% for small vessel disease, 5.9% for repeat CABG, and 0% for both varicose/stripped saphenous veins and routine cases (P < 0.05). Logistic regression analysis identified small vessel disease, insufficient grafting, age of > = 60 years, a history of smoking, a family history of ischaemic heart disease, and female gender as independent risk factors for early mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery

“…More recent studies have suggested that on average, women have a disadvantageous preoperative clinical profile that may account for much of this perceived difference. This includes the fact that women present for treatment at an older age, with poorer LV function, more frequently with unstable angina pectoris, NYHA Class IV heart failure, 3-vessel and left main disease, and more comorbid conditions including hypothyroidism, renal disease, diabetes mellitus, hypertension, and PVD (25,(480)(481)(482)(483)(484)(485)(486)(487)(488)(489). Based on these differences, it has been inferred that women may be under-referred or referred late for treatment and/or coronary angiography.…”

The care of patients with ischaemic heart disease from a gender perspective

“…In part, this less aggressive treatment of women's disease can be explained by the early results [5] from bypass operations, where a five-fold increased risk of death was found among women. In a number of studies it has been possible to credit the reason for this to the higher age of the women [6,[63][64][65][66][67] , less body surface and thus smaller coronary arteries [64,65] , more diabetes [63][64][65][66][67] , high blood pressure [65][66][67] , cardiac failure [6,66] , more widespread changes in the coronary arteries [63] , and acute operations owing to unstable angina [6,63,64,66] . Rahimtoola, et al however, point out in a report from 1993 [68] that a bypass operation is an effective form of treatment for angina (at a follow-up of 15-20 years) in both women and men.…”

Functioning of aortocoronary bypass grafts depending on the lesion and on the anatomical characteristics of coronary arteries

“…J. Ramström и соавт. предлагают следующие интраопераци-онные критерии артерии малого калибра: макси-мальный размер зонда, проводимого через арте-риотомное отверстие в дистальном направлении артерии, составляет 1 мм или, в случае сочетания с тяжелым дистальным атеросклеротическим по-ражением этой коронарной ветви -1,5 мм [4]. Все исследователи сходятся во мнении, что диаметр артерии надо определять посредством интраопе-рационного зондирования после артериотомии.…”

“…По данным литературы, об-щее количество неполной реваскуляризации со-ставляет от 9 до 40% [24]. Столь большой разброс данных, вероятно, связан с тем, что одни хирурги шунтируют коронарные артерии с диаметром не менее 1,5 мм и даже 2 мм и без выраженных вну-трисосудистых изменений [6], тогда как другие реваскуляризуют все гемодинамически значимые пораженные сосуды с диаметром от 1,25 мм неза-висимо от состояния дистального русла [4].…”