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Arterial revascularization. 18-year experience with coronary artery bypass grafting in familial hypercholesterolemia
M Kawasuji1, N Sakakibara, H Takemura
1Department of Surgery (I), Kanazawa University School of Medicine, Japan.
Insights
For familial hypercholesterolemia patients undergoing coronary artery bypass grafting, single arterial grafts improved long-term survival. Multiple arterial grafts did not provide additional survival benefits compared to single arterial grafts.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Genetics
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high cholesterol levels and accelerated coronary heart disease.
- Coronary artery bypass grafting (CABG) is a common treatment for advanced coronary artery disease.
- The internal thoracic artery is a preferred graft for CABG.
Purpose of the Study:
- To investigate the benefits of multiple arterial grafting versus single arterial grafting in patients with familial hypercholesterolemia.
- To compare long-term survival and freedom from recurrent angina among different grafting strategies in FH patients.
Main Methods:
- Retrospective analysis of 95 familial hypercholesterolemia patients undergoing 103 CABG procedures between 1980 and 1998.
- Patients were categorized into three groups: saphenous vein grafts only, one arterial graft with vein grafts, and multiple arterial grafts.
- Actuarial survival and freedom from recurrent angina rates were calculated and compared between groups.
Main Results:
- The overall 10-year actuarial survival rate was 90.9%, and 18-year survival was 81.8%.
- Patients receiving one arterial graft (Group 2) showed significantly higher survival rates than those with only vein grafts (Group 1, p < 0.05).
- No significant difference in survival or cardiac events was observed between patients with single arterial grafts (Group 2) and multiple arterial grafts (Group 3).
Conclusions:
- Single arterial grafting in CABG offers improved long-term survival for patients with familial hypercholesterolemia.
- Employing multiple arterial grafts does not confer additional survival advantages over single arterial grafts in this patient population.
Abstract:
Familial hypercholesterolemia is characterized by a high plasma level of cholesterol and is frequently associated with rapidly progressing coronary heart disease. The internal thoracic artery is recognized as the conduit of choice for coronary artery bypass grafting. This study was performed to determine whether multiple arterial grafting was associated or not with additional benefits for patients with familial hypercholesterolemia. Between June 1980 and March 1998, 95 patients with familial hypercholesterolemia. underwent a total of 103 coronary artery bypass procedures with one hospital death. The patients were divided into 3 groups according to the type of bypass graft. Group 1 included 31 patients with only saphenous vein grafts; Group 2,48 patients with one arterial graft and supplemental vein grafts; and Group 3, 24 patients with multiple arterial grafts. The overall actuarial survival rate was 90.9% at 10 years and 81.8% at 18 years. The overall actuarial freedom from recurrent angina was 68.9% at 10 years and 55.8% at 16 years. The actuarial survival rate in group 2 was higher than that in Group 1 (p < 0.05). There was no difference in the actuarial survival or in the freedom from cardiac events between Group 2 and Group 3. Single arterial grafting improved the long-term survival in patients with familial hypercholesterolemia. However, no additional benefit from multiple arterial grafting was identified.