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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Midterm angiographic follow-up after off-pump coronary artery bypass: serial comparison using early, 1-year, and
Ki-Bong Kim1, Kwang Ree Cho, Dong Seop Jeong
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea. kimkb@snu.ac.kr <kimkb@snu.ac.kr>
Insights
Graft patency after off-pump coronary artery bypass surgery remains acceptable at 5 years. Arterial grafts improve over time, while saphenous vein grafts show increasing moderate lesions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Off-pump coronary artery bypass (OPCAB) surgery is a common revascularization technique.
- Long-term graft performance is crucial for patient outcomes after coronary artery bypass grafting (CABG).
- Understanding anastomotic site changes is vital for assessing OPCAB efficacy.
Purpose of the Study:
- To evaluate angiographic changes and graft patency at the anastomotic sites up to 5 years post-OPCAB surgery.
- To compare the midterm performance of different graft types (arterial vs. venous) after OPCAB.
- To assess the influence of graft location on patency rates.
Main Methods:
- Analysis of coronary angiograms from 240 patients who underwent OPCAB surgery.
- Follow-up angiograms were obtained at early, 1-year, and 5-year intervals.
- Graft morphology was assessed using the FitzGibbon grading system.
Main Results:
- Overall graft patency (FitzGibbon grade A+B) was 98.6% early, 91.9% at 1 year, and 88.3% at 5 years.
- Graft patency in the left anterior descending artery territory was significantly higher than in other territories at 1 and 5 years.
- Arterial grafts initially graded B showed improvement to grade A by 5 years, whereas saphenous vein grafts showed a progressive increase in grade B lesions.
Conclusions:
- Midterm angiographic follow-up confirms acceptable graft patency after OPCAB surgery.
- Arterial grafts demonstrate favorable remodeling and improvement in morphology over 5 years.
- Saphenous vein grafts exhibit a gradual increase in moderate lesions, indicating potential for later degeneration.
Objective:
We analyzed the angiographic changes of the anastomotic sites at three time points for 5 years after off-pump coronary artery bypass surgery.
Methods:
Of the 402 patients who underwent off-pump coronary artery bypass surgery between January 1998 and December 2001, 240 patients who received the early, 1-year, and 5-year follow-up coronary angiograms regardless of the patient's anginal symptoms were studied. Morphologic changes of grafts were traced by the FitzGibbon grading system.
Results:
Overall graft patency rates (FitzGibbon grade A+B) at early, 1-year, and 5-year angiography were 98.6%, 91.9%, and 88.3%, respectively. Graft patency rates in the left anterior descending artery, left circumflex artery, and right coronary artery territories were similar at early angiograms (P = .162). However, graft patency rate in the left anterior descending artery territory was higher than that in the left circumflex artery and right coronary artery territories at both the 1-year (P < .001) and 5-year (P < .001) angiograms. Of the 31 FitzGibbon grade B arterial grafts (internal thoracic artery and right gastroepiploic artery) at early angiography, 10 became occluded and 19 became grade A at 5-year angiography. In the saphenous vein grafts, grade B lesions gradually increased during the 5 postoperative years (2.6% vs 6.5% vs 13.3%).
Conclusions:
Midterm angiographic follow-up demonstrated acceptable patency rates of grafts after off-pump coronary artery bypass surgery. Approximately half of the FitzGibbon grade B arterial grafts in the early angiograms became grade A at 5 years after surgery, but the proportion of grade B saphenous vein grafts gradually increased over the 5 postoperative years.
