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[Coronary artery bypass surgery in patients with familial hypercholesterolemia]
T Tedoriya1, M Kawasuji, N Sakakibara
1Department of Surgery (1), Kanazawa University School of Medicine, Japan.
Insights
Coronary artery bypass grafting (CABG) is effective for familial hypercholesterolemia (FH) patients. Arterial grafts show excellent long-term patency and survival rates, comparable to non-FH individuals.
Area of Science:
- Cardiovascular Surgery
- Medical Genetics
- Vascular Biology
Context:
- Familial hypercholesterolemia (FH) is a genetic disorder causing severe hypercholesterolemia and premature atherosclerosis.
- Coronary artery disease (CAD) in FH patients often requires surgical intervention like CABG.
- Assessing the long-term outcomes of CABG in FH patients is crucial for treatment optimization.
Purpose:
- To evaluate the efficacy and safety of coronary artery bypass grafting (CABG) in patients with heterozygous familial hypercholesterolemia (FH).
- To compare graft patency, survival rates, and cardiac event-free rates between arterial and venous grafts in FH patients undergoing CABG.
- To assess the histological characteristics of arterial grafts in FH patients post-CABG.
Summary:
- CABG was performed in 48 FH patients, with 79% having multi-vessel or left main trunk disease.
- Graft patency at one month was 95% for vein grafts and 100% for arterial grafts (97% overall).
- Eleven-year survival was 83% without cardiac death; cardiac event-free rates at 10 years were 53% (vein) and 58% (overall), but 93% at 5 years for arterial grafts.
Impact:
- CABG, particularly with arterial grafts and optimal medical therapy, offers favorable long-term outcomes for FH patients.
- Arterial grafts demonstrated excellent patency and structural integrity, without signs of atherosclerosis in FH patients.
- These findings support the use of CABG as a viable revascularization strategy in carefully selected FH patients, similar to non-FH populations.
Abstract:
Coronary artery bypass grafting (CABG) was performed in 48 patients with heterozygous familial hypercholesterolemia (FH). Seventy-nine percent of these patients had three-vessel disease or left main trunk disease. The internal thoracic artery was used for grafting in 26 patients and the right gastroepiploic artery was used in 4 patients. Although no patient died during surgery, one died subsequently from graft-versus-host disease. Graft patency at one month after CABG was 95% in vein grafts, 100% in arterial grafts, and 97% overall. Histological study revealed that arterial grafts in patients with FH had similar structures to those in non-FH patients, without evidence of atherosclerosis. All patients were prescribed anti-cholesterol drugs to control serum cholesterol levels, and 4 patients underwent LDL-apheresis because of poor control. Survival rate at 11 years after CABG was 83% without cardiac death. Cardiac event-free rate in 47 surviving patients was 53% at 10 years after CABG in vein bypass group, 93% at 5 years in the arterial graft group, and 58% at 10 years overall. Results of CABG were as good in FH as in non-FH patients, using arterial grafts and anticholesterol therapy.