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Published on: November 19, 2019
Graft selection and one-year patency rates in patients undergoing coronary artery bypass grafting
Toshihiro Fukui1, Minoru Tabata, Susumu Manabe
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan. tfukui-cvs@umin.ac.jp
Insights
Coronary artery bypass grafting using multiple arterial grafts is safe and effective. Bilateral internal thoracic artery grafts demonstrate the highest long-term patency rates, offering a reliable strategy for coronary revascularization.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for coronary artery disease.
- Assessing graft patency is essential for long-term surgical success.
- Off-pump CABG has become increasingly prevalent.
Purpose of the Study:
- To evaluate the angiographic patency rates of various grafts utilized in coronary artery bypass surgery.
- To compare the long-term efficacy of different graft types in isolated CABG procedures.
Main Methods:
- Retrospective review of 930 patients undergoing isolated CABG between 2004 and 2009.
- 95.1% of patients underwent off-pump CABG.
- Early and 1-year angiographic graft patency was assessed for multiple graft types.
Main Results:
- Overall early graft patency was 97.4%, decreasing to 87.5% at 1 year.
- One-year patency rates varied by graft type: Left Internal Thoracic Artery (96.1%), Right Internal Thoracic Artery (92.0%), Gastroepiploic Artery (81.4%), Saphenous Vein Graft (82.6%), and Radial Artery (69.5%).
- Radial artery grafts showed significantly lower 1-year patency compared to free right internal thoracic artery and saphenous vein grafts.
Conclusions:
- Coronary artery bypass grafting with diverse arterial graft combinations is clinically safe and effective.
- Bilateral internal thoracic artery grafting for the left coronary system represents the most reliable strategy based on angiographic patency.
- Graft selection significantly impacts long-term patency in coronary revascularization.
Background:
The aim of this study was to assess the angiographic patency rates of grafts used for coronary artery bypass surgery.
Methods:
We reviewed the records of 930 patients who underwent isolated coronary artery bypass grafting between September 2004 and June 2009. Of these patients, 95.1% underwent off-pump coronary artery bypass grafting. Early and 1-year angiographic patency rates of grafts were assessed.
Results:
Mean anastomoses per patient were 4.0 +/- 1.3. Operative mortality was 0.5%. Stroke occurred in 2.2% of patients, and 1.3% had mediastinitis. Early and 1-year patency rate of total grafts was 97.4% and 87.5%, respectively. One-year patency rate of the left internal thoracic artery, right internal thoracic artery, radial artery, gastroepiploic artery, and saphenous vein graft was 96.1%, 92.0%, 69.5%, 81.4%, and 82.6%, respectively. One-year patency rates of in situ and free right internal artery graft were not significantly different (p = 0.13). One-year patency rate of the radial artery was significantly worse than that of the free right internal thoracic artery graft (p < 0.01) and saphenous vein graft (p < 0.01).
Conclusions:
Multiple coronary arterial revascularizations in various combinations of grafts were clinically safe and effective for isolated coronary artery bypass surgery. Bilateral internal thoracic artery grafting for the left coronary artery system was the most reliable strategy as shown by angiographic patency rates.
