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Evaluation of early coronary graft patency after coronary artery bypass graft surgery using multislice computed
Hosseinali Bassri1, Farzad Salari, Fereidoun Noohi
1Department of Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. drbassiri@yahoo.com
Insights
Coronary artery bypass graft (CABG) surgery early patency rates show internal mammary artery (IMA) grafts are most successful. Other arterial grafts had high acute occlusion rates, highlighting the need for improved surgical techniques.
Area of Science:
- Cardiology
- Vascular Surgery
- Medical Imaging
Background:
- Coronary artery bypass graft (CABG) surgery is a standard treatment for advanced coronary artery disease.
- Graft failure significantly impacts long-term CABG outcomes.
- Evaluating early graft patency is crucial for assessing surgical success.
Purpose of the Study:
- To assess the early patency rates of various coronary bypass grafts.
- To identify factors influencing graft patency after CABG surgery.
Main Methods:
- 107 consecutive patients undergoing CABG were included.
- Computed tomography (CT) angiography was used to evaluate graft patency within the first week post-surgery.
- Graft patency was analyzed based on graft type (venous vs. arterial) and anatomical location.
Main Results:
- Overall acute occlusion rate was 8.7% (32/366 grafts), with higher rates in venous grafts (10%) compared to arterial grafts (5%).
- Left internal mammary artery (IMA) grafts demonstrated the highest patency rate (97.3%).
- Radial artery and right IMA grafts showed lower patency (50%), and some venous grafts also experienced occlusions, particularly in the left circumflex (LCX) and right coronary artery (RCA) territories.
Conclusions:
- IMA grafts exhibit superior early patency rates in CABG surgery.
- Other arterial grafts, such as radial artery grafts, are associated with a significant risk of acute occlusion.
- Longer pump times were correlated with higher rates of graft occlusion.
Background:
Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease, and its long-term results are affected by the failure of bypass grafts. The aim of the present study was to evaluate the early patency rate in coronary bypass grafts.
Methods:
A total of 107 consecutive patients who underwent CABG were included in this study. Early graft patency was evaluated via computed tomography (CT) angiography in the first week after surgery.
Results:
There were a total of 366 grafts, comprised of 250 venous grafts and 116 arterial grafts. Multi-slice CT detected acute graft occlusions in 32 (8.7%) of all the grafts, including 26 (10%) of the 250 venous grafts and 6 (5%) of the 116 arterial grafts. The patency rates obtained were 97.3% for the left internal mammary (IMA) grafts, 50% for the radial artery grafts, and 50% for the right IMA grafts. Additionally, 107 (96.4%) grafts to the left anterior descending artery (LAD) were classified as patent, whereas 1 (30%) of the 3 grafts in the left circumflex (LCX) region and 1 (50%) of the 2 grafts in the right coronary artery (RCA) territory were found to be occluded. In the venous category, 8 (13.7%) of the 58 grafts to LAD were found to be occluded. In the LCX region, 9 (8.5%) of the 106 grafts were classified as occluded, while the remaining 97 (91.5%) grafts were patent. The venous grafts to RCA were occluded in 9 (10.4%) of the 86 grafts. Amongst the multiple preoperative, intraoperative, and postoperative factors, pump time was significantly longer in the patients with occluded grafts than in those with patent grafts (P=0.04).
Conclusion:
The IMA grafts had the highest early patency rate amongst the coronary bypass grafts. However, the other arterial grafts were associated with a high rate of acute occlusions.
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