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Fate of bypass grafts onto totally occluded coronary arteries
1Department of Thoracic and Cardiovascular Surgery, University Frankfurt am Main, Germany. mirkodoss@aol.com
Insights
Bypass graft failure is significantly higher in totally occluded coronary arteries with retrograde flow. This finding highlights the risks associated with revascularizing these specific coronary artery types.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Chronically occluded coronary arteries can develop collateral circulation, leading to retrograde perfusion.
- Retrograde flow in coronary arteries is linked to competitive flow and increased risk of bypass graft failure.
- Understanding the impact of retrograde flow on graft patency is crucial for surgical outcomes.
Purpose of the Study:
- To investigate the patency rate of bypass grafts in totally occluded coronary arteries with retrograde flow.
- To compare graft failure rates between arteries with and without retrograde flow.
- To assess the clinical significance of retrograde flow on early graft success.
Main Methods:
- A comparative study involving two groups of patients undergoing coronary artery bypass grafting (CABG).
- Group 1: 33 patients with three-vessel disease, one totally occluded artery, and preoperative retrograde flow evidence.
- Group 2 (control): 30 patients with three-vessel disease but no totally occluded coronaries. Graft patency assessed one month post-CABG.
Main Results:
- Graft occlusion rate was 36.36% (12 grafts) in bypasses to totally occluded arteries with retrograde flow.
- The control group exhibited a graft failure rate of 13.3%.
- The difference in graft failure between the groups was statistically significant (p=0.03).
Conclusions:
- Revascularization of totally occluded coronary arteries with preoperative retrograde flow is associated with a significantly increased incidence of early bypass graft failure.
- Retrograde flow is a critical factor predicting early graft occlusion in CABG surgery.
- These findings suggest caution when performing bypass grafting onto coronary arteries with retrograde perfusion.
Background:
Chronically occluded coronary arteries often develop good collateralisation, that leads to retrograde perfusion of these vessels, as regularly seen in coronary angiograms. Retrograde perfusion constitutes a form of competitive flow, which in turn is associated with an increased risk for early bypass graft failure. The aim of our study is to investigate the patency rate of bypass grafts onto totally occluded coronary arteries, in the presence of retrograde flow.
Methods:
Two groups of patients were followed up by cardiac catheterisation. One month after undergoing coronary artery bypass grafting. Group 1 (n=33) had coronary three vessel disease, with one totally occluded coronary artery and evidence of retrograde flow in the preoperative coronary angiogram. Group 2 (n=30) was the control group, with coronary three vessel disease and without totally occluded coronaries. We used internal mammary arteries and saphenous vein grafts as conduits.
Results:
Thirty-six point thirty-six per cent of bypass grafts onto totally occluded coronaries were occluded one month postoperatively (n=12). Graft failure in the control group was 13.3%. Significance p=0.03.
Conclusions:
In view of our findings we conclude, that there is a significantly increased incidence of early graft failure, when totally occluded coronary arteries are revascularised, that show retrograde flow in the preoperative coronary angiogram.
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