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Coronary artery bypass surgery with arterial grafts in familial hypercholesterolemia
M Kawasuji1, N Sakakibara, S Fujii
1Department of Surgery (I), Kanazawa University School of Medicine, Kanazawa, Japan.
Insights
Arterial grafting improves long-term outcomes for familial hypercholesterolemia patients, reducing reoperation rates. Multiple arterial grafts did not show additional benefits over single arterial grafts.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Vascular Biology
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder linked to premature coronary artery disease.
- Caused by low-density lipoprotein receptor gene mutations, FH necessitates effective long-term management strategies.
Purpose of the Study:
- To evaluate the long-term efficacy of arterial grafting in patients with familial hypercholesterolemia.
- To compare outcomes between different arterial grafting strategies and vein grafts.
Main Methods:
- A cohort of 101 patients with heterozygous FH underwent coronary artery bypass grafting.
- Patients received saphenous vein grafts (Group 1) or arterial grafts (Group 2: 2A single internal thoracic artery, 2B multiple arterial grafts).
- All patients received intensive medical therapy, including cholesterol-lowering drugs and apheresis where indicated.
Main Results:
- Over a mean 95-month follow-up, arterial grafting (Group 2) significantly improved survival compared to vein grafts (Group 1).
- Freedom from reoperation was higher in Group 2 versus Group 1 (P=.03).
- No significant difference in survival or cardiac events was observed between single (2A) and multiple (2B) arterial grafts.
Conclusions:
- Arterial grafting enhances long-term freedom from reoperation in familial hypercholesterolemia patients.
- The use of multiple arterial grafts does not provide additional benefits over single arterial grafts in this patient population.
Objective:
Familial hypercholesterolemia is a dominantly inherited disorder caused by mutations at the locus for the low-density lipoprotein receptor and is frequently associated with premature coronary artery disease. This study was performed to determine whether arterial grafting was associated with long-term benefits for patients with familial hypercholesterolemia.
Methods:
During the past 18 years, 101 patients with heterozygous familial hypercholesterolemia underwent primary coronary artery bypass grafting, with one hospital death. Group 1 patients (n = 31) received only saphenous vein grafts. Group 2A patients (n = 47) received one internal thoracic artery graft and supplemental vein grafts, and group 2B patients (n = 23) had multiple arterial grafts. After operation, all patients received diet therapy and intensive cholesterol-lowering drug therapy. Thirteen patients received low-density lipoprotein apheresis.
Results:
During a mean follow-up period of 95 months, 8 patients died, 9 underwent reoperation, and 12 received catheter intervention. The overall survival was 82% (95% confidence limits, 65%-97%) at 18 years after operation. The survival in group 2 was higher than that found in group 1 (P =.01). The overall freedom from major cardiac events (myocardial infarction, cardiac death, reoperation, and catheter intervention) was 57% (95% confidence limits, 40%-74%) at 16 years after operation. The freedom from reoperation in group 2 was higher than that found in group 1 (P =.03). There was no difference in the survival or freedom from major cardiac events between groups 2A and 2B.
Conclusion:
Arterial grafting improved the long-term freedom from reoperation in patients with familial hypercholesterolemia. Additional benefit of multiple arterial grafting could not be identified.