Related Experiment Video
Updated: May 16, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Influence of chronic total occlusions on coronary artery bypass graft surgical outcomes
Subhash Banerjee1, Ryan G Master, Matthias Peltz
1VA North Texas Health Care System, Dallas, Texas 75216, USA. subhash.banerjee@utsouthwestern.edu
Insights
Coronary artery bypass graft surgery (CABG) effectively treats chronic total occlusions (CTO). However, long CTOs (>40 mm) independently predict lower survival rates after CABG.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery chronic total occlusion (CTO) is associated with higher coronary artery bypass graft surgery (CABG) referral rates.
- The impact of CTO on CABG outcomes remains understudied.
Purpose of the Study:
- To systematically evaluate the impact of coronary artery CTO on CABG outcomes.
Main Methods:
- A retrospective analysis of 605 patients undergoing CABG between June 2005 and December 2008.
- One-year clinical outcomes were assessed, focusing on the presence and characteristics of CTOs.
Main Results:
- 42% of patients had CTOs, most commonly in the right coronary artery distribution.
- CABG demonstrated high success rates for CTO revascularization across major coronary arteries.
- While overall mortality and myocardial infarction rates were similar, CTOs longer than 40 mm were associated with significantly lower one-year survival.
Conclusions:
- CABG is a successful revascularization strategy for epicardial coronary CTOs.
- Long CTOs (>40 mm) are identified as an independent predictor of reduced post-CABG survival.
Background:
Presence of epicardial coronary artery chronic total occlusion (CTO) predicts higher referral rates for coronary bypass graft surgery (CABG). However, the impact of coronary artery CTO on CABG outcomes has never been systematically studied.
Method:
We examined one-year outcomes in 605 consecutive Veterans, discharged post-CABG between June 2005 and December 2008.
Results:
A coronary CTO was present in 256 patients (42%), predominantly (48.3%) in the right coronary artery distribution. Baseline clinical characteristics and medical therapy were similar in patients with and without a coronary CTO. A single CTO was present in 73.8%, and 26.2% patients had multiple CTO. All left anterior descending coronary artery CTO were successfully bypassed, as were >92% in left circumflex and right coronary arteries and 85% CTO in multiple coronary artery distributions. During the mean follow-up of 348.9 ± 4.5 days, incidence of all-cause death and myocardial infarction were similar in both groups (7.1% in CTO group and 7.4% in non-CTO group; p = 0.97). CTO >20 mm in length constituted 74.9% and >40 mm 37.8%. One-year survival post-CABG was significantly lower in patients with CTO lengths >40 mm compared to ≤20 mm (p = 0.04). CTO >40 mm was an independent predictor of post-CABG mortality controlling for age, number of CTO, comorbid diseases, clopidogrel use, severity of coronary artery disease, renal failure, and left ventricular ejection fraction.
Conclusion:
CABG achieves high success in grafting epicardial coronary vessels with CTO; however, presence of long coronary CTO (>40 mm) is an independent predictor of post-CABG survival.
More Related Videos
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
12:00Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model
Published on: November 24, 2014
