Serial Angiographic Follow-up Beyond 10 Years After Coronary Artery Bypass Grafting

Abstract

n 1962, Sabiston performed the first case of coronary artery bypass grafting (CABG) to the right coronary artery, using a reversed segment of saphenous vein, but the patient died of a postoperative accident. 1 Green et al used a left internal thoracic artery (LITA), and anastomosed its distal end to the left anterior descending coronary artery (LAD). 2 Favalore established the use of saphenous vein grafts (SVGs) for multivessel bypass. 3 In Japan, CABG is also widely performed; for example, since 1975 in Juntendo University School of Medicine. However, the long-term prognosis and serial angiographic follow-up beyond 10 years in patients who have undergone CABG have not been fully studied in Japan, so we investigated those who underwent CABG before 1992 and performed a clinical and serial angiographic follow-up. Methods Study PatientsWe selected 71 patients who underwent CABG before 1992 and were willing to undergo the long-term clinical and angiographic follow-up. All patients underwent CABG in Juntendo University School of Medicine and were followed in Juntendo Urayasu hospital. Of these patients, 30 had a SVG only, and the remaining 41 had a LITA to LAD graft. We investigated clinical course and prognosis, and coronary risk factors of the patients with SVG alone (SVG group) and compared them with the patients with LITA (LITA group). All patients in the SVG group had a SVG to LAD graft, whereas in the LITA group, all patients had LITA to LAD and SVG to the other coronary vessels. The major adverse cardiac events (MACE) were defined as cardiac death, Q-wave or nonQ-wave myocardial infarction, and congestive heart failure. Hyperlipidemia was defined as requiring antihyperlipidemic drugs or a total cholesterol (TC) >220 mg/dl. Diabetes mellitus (DM) was defined as a requirement for therapy with medication and/or with a fasting blood sugar (FBS) of more than 140 mg/dl, and/or a blood sugar >200 mg/dl on occasion. Baseline clinical and procedural data were collected for all patients. Coronary AngiographyThe patients gave informed consent to undergo serial angiography at 1, 5 and 10 years after CABG, regardless of their symptoms. The films were of good quality and the repeat studies were always compared with the baseline coronary arteriograms. The films were each read by 2 angiographers working together to reach a consensus. Stenosis of the coronary arteries and grafts was defined as the linear percentage of narrowing of the diameter of the vessel compared with the diameter of the nearest normal segment. In this study, patent graft meant widely patent or stenosis less than 99% narrowing. Percutaneous coronary intervention (PCI) to the SVG and native coronary arteries Serial Angiographic Follow-up Beyond 10 Years After Coronary Artery Bypass GraftingMizuhiro Arima, MD* , **; Tatsuji Kanoh, MD**; Takeshi Suzuki, MD**; Kenichi Kuremoto, MD**; Kosei Tanimoto, MD**; Tetsuya Oigawa, MD**; Shigeru Matsuda, MD** Background The long-term prognosis and serial angiographic follow-up beyond 10 years in patients who underwent co...

Early and Mid-Term Impacts of Cardiopulmonary Bypass on Coronary Artery Bypass Grafting in Patients With Poor Left Ventricular Dysfunction A Propensity Score Analysis

“…[24][25][26][27] In the present study, there was a significant difference in the rates of total arterial revascularization and the number of arterial grafts. Although there may be several reasons why the total arterial revascularization did not affect late outcomes in the present study, we believe 2 are likely possibilities.…”

Đánh giá kết quả trung hạn phẫu thuật bắc cầu chủ vành ở bệnh nhân hẹp ba thân động mạch vành tại trung tâm tim mạch bệnh viện E

“…Cầu nối vào ĐMV hẹp ≥ 95% trƣớc mổ có tỉ lệ tắc hẹp thấp hơn (p = 0,009). [7]. Theo tổng kết của Taggart 90-95% cầu nối ĐMNT còn thông tốt sau 10-15 năm [8].…”

Hybrid myocardial revascularization - the cardiologist's view

“…Existuje rozsáhlá evidence o tom, že optimální chirurgickou revaskularizační metodou pro tuto tepnu je bypass s použitím levé arteria mammaria inter-na (left internal mammary artery -LIMA) [25][26][27]. Arteriální štěp s použitím LIMA má excelentní dlouhodobou průchodnost (až 98 % po jednom roce, 95 % po deseti letech a kolem 90 % po 15 a více letech) [28][29][30][31][32][33]. Ve studii BARI byl benefit v dlouhodobém přežití po CABG u pacientů s diabetem ve srovnání s léčenými angioplastikou pozorován pouze u těch, kterým byl RIA revaskularizován pomocí LIMA.…”