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Coronary artery bypass grafting in patients with systemic lupus erythematosus
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Japan.
Insights
Coronary artery bypass grafting (CABG) in patients with systemic lupus erythematosus (SLE) showed good early and late results. Internal thoracic artery and vein grafts are safe for SLE patients undergoing CABG.
Area of Science:
- Cardiovascular Surgery
- Rheumatology
- Transplantation Immunology
Background:
- Limited data exists on coronary artery bypass grafting (CABG) outcomes in patients with systemic lupus erythematosus (SLE).
- Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems, including the cardiovascular system.
Purpose of the Study:
- To evaluate the early and late results of CABG in patients with SLE.
- To assess the patency and integrity of internal thoracic artery (ITA) and saphenous vein grafts in SLE patients.
Main Methods:
- Retrospective review of seven SLE patients who underwent eight CABG procedures.
- Postoperative angiography to assess graft patency, stenosis, and atherosclerotic changes.
- Pathological examination of ITA and saphenous vein graft specimens for atherosclerosis and vasculitis.
Main Results:
- One hospital death (12.5%) and one late non-cardiac death.
- Early graft patency rate of 87.5% (21/24 grafts).
- No significant atherosclerosis or vasculitis found in ITA or vein grafts during pathological studies and follow-up angiography.
Conclusions:
- CABG can be performed in SLE patients with acceptable morbidity and mortality.
- Internal thoracic artery (ITA) and saphenous vein grafts appear safe and effective for CABG in SLE patients.
Objective:
Few reports exist on the results of coronary artery bypass grafting (CABG) in patients with systemic lupus erythematosus (SLE).
Methods:
We retrospectively reviewed eight CABG in seven SLE patients. In early and late postoperative angiography, all grafts were evaluated for occlusion, development of string sign, or presence of significant stenosis. The early and late results were compared. The pathological studies were performed on the segments of the internal thoracic artery (ITA) and saphenous vein collected from each patient. Atherosclerosis of the ITA was analyzed using the subjective evaluation proposed by Kay et al. (Kay HR, Korns ME, Flemma RJ, Tector AJ, Lepley D. Atherosclerosis of the internal mammary artery. Ann Thorac Surg 21;1976:504-507) scale 0-4 (0 = normal, 1 = minimal disease, 2 = less than 25% luminal narrowing, 3 = 25-50% narrowing, and 4 = greater than 50% narrowing).
Results:
The patients consisted of three men and four women with a mean age of 59.8 years. Co-morbid diseases were frequent and there were three patients (37.5%) with renal failure (two dialysis patients, one with renal dysfunction) and two patients with severe atherosclerosis of the aorta. The ITA was used in four patients. Saphenous vein graft was used in seven patients. Concomitant procedures included aortic valve replacement and mitral annuloplasty, mitral valvuloplasty and tricuspid annuloplasty, mitral valve replacement and tricuspid annuloplasty (TAP). There was one hospital death (12.5%). Early patency rates were 87.5% (21/24). No other atherosclerotic changes or stenosis suggesting vasculitis were noted. In pathological studies, there was no significant atherosclerosis in the six ITA specimens from four patients, although three patients had degree two atherosclerosis. No vasculitis was found in ITA or saphenous vein grafts. During the mean follow-up period of 35.3 months (range, 5-91 months), there was one non-cardiac late death. Late restudy (in three patients, 12, 57 and 64 months later respectively) revealed no deterioration in either ITA or vein grafts. Overall prognosis after the operation in SLE patients appears to be good. No other cardiac events were observed, and patients demonstrated marked clinical improvement.
Conclusions:
CABG in SLE patients can be performed with acceptable morbidity and mortality. Our data so far reveals no evidence to preclude the use of ITA and vein grafts in SLE patients.