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Published on: January 14, 2014
Graft pathology at the time of harvest: impact on long-term survival
Shi-Min Yuan1, Yun Li2, Yan Hong Ben3
1The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, People's Republic of China.
Insights
Pathological changes in the left internal mammary artery (IMA) graft at harvest negatively impact long-term survival after coronary artery bypass grafting. Preserving IMA graft integrity is crucial for patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Pathology
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) relies on graft patency for long-term success.
- Graft pathology at the time of harvest may influence post-operative outcomes.
- Understanding pre-harvest graft condition is essential for predicting graft survival.
Purpose of the Study:
- To investigate graft pathology in coronary artery bypass grafts at the time of harvest.
- To determine the impact of pre-harvest graft pathology on long-term patient survival.
- To identify risk factors associated with graft failure and reduced survival.
Main Methods:
- Pathological examination of bypass grafts (left internal mammary artery, radial artery, saphenous vein) from 66 CABG patients.
- Analysis of predictive risk factors and patient survival data.
- Application of multinomial logistic regression and Kaplan-Meier survival analysis.
Main Results:
- Medial degenerative changes were common in all graft types (35-38%).
- Left internal mammary artery (IMA) pathological changes were significantly associated with reduced long-term survival (74.1% vs. 91.4%, P=0.002).
- Pathology in radial artery or saphenous vein grafts did not significantly affect long-term survival.
Conclusions:
- Pre-harvest pathological changes in the left IMA graft, unlike other grafts, significantly impact long-term patient survival.
- Minimizing trauma during IMA harvest, managing dyslipidemia, and avoiding composite grafts may preserve graft architecture and improve outcomes.
Objective:
This study aims to present the graft pathology at the time of harvest and its impact on long-term survival.
Methods:
The remnants of the bypass grafts from 66 consecutive patients with coronary artery disease receiving a coronary artery bypass grafting were investigated pathologically, and pertinent predictive risk factors and survival were analyzed.
Results:
Medial degenerative changes with or without intimal proliferation were present in 36.8%, 37.8% and 35.6% of left internal mammary artery (IMA), radial artery and saphenous vein grafts. There were 2 (3.0%) hospital deaths and 9 (14.1%) late deaths. Multinomial logistic regression revealed left IMA pathological changes, dyslipidemia, history of percutaneous transluminal coronary angioplasty/stent deployment and Y-graft were significant predictive risk factors negatively influencing the patients' long-term survival. Kaplan-Meier survival analysis revealed that the long-term survival of patients with left IMA pathological changes were significantly reduced compared with those without (74.1% vs. 91.4%, P=0.002); whereas no differences were noted in long-term survivals between patients with and without pathological changes of the radial arterial or saphenous vein grafts.
Conclusion:
Pathological changes may be seen in the bypass graft at the time of harvest. The subtle ultrastructural modifications and the expressions of vascular tone regulators might be responsible for late graft patency. The pathological changes of the left IMA at the time of harvest rather than those of the radial artery or saphenous vein graft affect significantly longterm survival. Non-traumatic maneuver of left IMA harvest, well-controlled dyslipidemia and avoidance of using composite grafts can be helpful in maintaining the architecture of the grafts.
