Related Experiment Videos
[Coronary artery bypass graft dysfunction--clinical presentation, laboratory and electrocardiographic parameters]
T Weber1, R Berent, A Kirchgatterer
1II. Internen Abteilung mit Kardiologie, I. Chirurgischen Abteilung für Herz- und Thoraxchirurgie des A. ö. Krankenhauses der Barmherzigen Schwestern vom Heiligen Kreuz, Grieskirchnerstrasse 42, A-4600 Wels. webertom@liwest.at
Insights
Long-term patency of arterial bypass grafts, like the left internal mammary artery (LIMA), remains high after coronary artery bypass surgery. Venous bypass graft (VBP) patency declines over time and is linked to patient factors and inflammation.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Clinical Cardiology
Context:
- Recurrent symptoms after coronary artery bypass surgery (CABG) are often linked to bypass graft dysfunction.
- Understanding factors influencing long-term graft patency is crucial for patient outcomes.
- This study retrospectively analyzed graft patency in patients undergoing coronary angiography.
Purpose:
- To determine factors associated with the long-term patency of arterial and venous bypass grafts following CABG.
- To investigate the relationship between graft function and clinical presentation, physiological parameters, and inflammatory markers.
Summary:
- Left internal mammary artery (LIMA) grafts demonstrated high patency (92% at 53 months) with minimal dysfunction.
- Venous bypass graft (VBP) patency significantly decreased over time (74% at 5 years to 35% at >10 years, p < 0.01).
- VBP function correlated with clinical presentation (angina type), resting ECG, body mass index, and erythrocyte sedimentation rate (ESR).
Impact:
- Findings highlight the superior long-term durability of arterial grafts (LIMA) compared to venous grafts.
- Identifies patient-specific factors (BMI, ECG, ESR) and clinical presentation as predictors of venous graft dysfunction.
- Suggests inflammatory processes play a significant role in the development of venous graft atherosclerosis and dysfunction.
Abstract:
The recurrence of symptoms after coronary artery bypass surgery is often caused by bypass-dysfunction. In this study we tried to determine factors related to the long-term patency of arterial and venous bypass grafts. We evaluated all patients with bypass grafts undergoing coronary angiography in the year 1998 at our hospital (163 patients, mean age 67 years, mean interval since the operation 79 months, a total of 341 venous bypasses (VBP), 386 peripheral venous anastomoses and 85 arterial (LIMA = left internal mammarial artery) bypasses. The data were collected by a retrospective analysis of the hospital records. Statistics were performed using the Wilcoxon-Mann-Whitney-U test. After an interval of 53 months LIMA-bypasses were patent without stenosis in 92%. Symptoms were caused in only 2% by a dysfunction of the LIMA-graft. The patency of venous bypass grafts decreased with time (5 years after the operation 74% were patent without stenosis, 5-10 years 56%, more than 10 years 35%, p < 0.01). We found clear relations between the function of the venous grafts and the clinical presentation (patent grafts without stenosis in 43% with acute coronary syndromes, in 57% with stable angina [p = 0.08] and in 86% with atypical angina [p < 0.0001 for the difference between each of the first two and the last syndrome]), the resting-ECG (65% patent VBP without stenosis with normal ST-segments and 49% with abnormal ST-segments, p < 0.01), the body-mass-index (70% patent VBP without stenosis with a BMI < 25 and 56% with a BMI > 30, p = 0.05) and the erythrocyte sedimentation rate after 2 hours (79% patent VBP with an ESR < or = 20 mm vs. 64% with an ESR > 49 mm, p = 0.02). The function of VBP after coronary artery bypass graft (CABG)-procedure depends primarily upon the interval since the operation. In addition, we found correlations with clinical presentation, resting-ECG, body-mass-index and erythrocyte-sedimentation rate as a possible marker of inflammation in bypass-atherosclerosis. Therefore, inflammatory processes seem to play an important role in the development of venous graft dysfunction.