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Results of multiple coronary artery bypass grafting in Japanese patients
Insights
Multiple coronary artery bypass grafting with over four grafts is safe and effective for severe multivessel disease. This procedure offers favorable outcomes and good graft patency, without increasing surgical risk.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Severe multivessel coronary artery disease often requires complex surgical interventions.
- The safety and efficacy of extensive coronary artery bypass grafting (CABG) with more than four grafts remain a subject of investigation.
- Understanding outcomes and graft patency in patients undergoing multiple CABG is crucial for treatment planning.
Purpose of the Study:
- To evaluate the outcomes and graft patency of multiple coronary artery bypass grafting (CABG) involving more than four grafts.
- To assess the surgical risk associated with an increased number of coronary artery anastomoses.
- To determine the effectiveness of extensive CABG in patients with severe multivessel coronary artery disease.
Main Methods:
- Retrospective analysis of 64 Japanese patients undergoing CABG with >4 grafts over 3.5 years.
- Utilized saphenous vein grafts (SVG), internal mammary artery (IMA), and right gastroepiploic artery (RGEA) grafts.
- Assessed early and late mortality, new Q waves, need for intraaortic balloon pumping (IABP), and graft patency within 6 months.
Main Results:
- Mean grafts: 4.4 (range 4-7). Mean aortic cross-clamp time: 74.5 min; cardiopulmonary bypass time: 134.3 min.
- Graft patency at 6 months: SVG 86%, IMA 96%, RGEA 100%.
- Early/late deaths: 3.1% each. New Q waves: 3.1%. IABP required: 4.7%. Angina relief in 96.7% of survivors.
Conclusions:
- Increasing the number of coronary artery anastomoses in CABG does not elevate surgical risk.
- Multiple grafting provides favorable outcomes and acceptable graft patency for severe multivessel coronary artery disease.
- Extensive CABG is a viable option for complex coronary artery disease patients.
Abstract:
Multiple coronary artery bypass grafting with more than 4 grafts has been carried out in 64 Japanese patients during a 3.5 year period. There were 55 males and 9 females; ages ranged from 34 to 75 with a mean of 58.9 years old. Double, triple and left main disease were noted in one (2%), 54 (84%) and 9 (14%) patients, respectively. There was 54 (84%) stable and 10 (16%) unstable angina pectoris, and 28 (44%) patients had previous myocardial infarction. The saphenous vein graft was used for all patients with a preferential use of sequential graft (84%). The internal mammary artery graft was used in 55 (86%) patients and the right gastroepiploic artery graft was used in 6 (9%) patients. There were 2 (3.1%) early and 2 (3.1%) late deaths. New Q wave was noted in 2 (3.1%) patients and intraaortic balloon pumping was required in 3 (4.7%) patients. The mean number of grafts was 4.4 ranged from 4 to 7, and the mean aortic cross clamp time and cardiopulmonary bypass time was 74.5 min and 134.3 min, respectively. Graft patency within 6 postoperative months was 86% (120/140) in saphenous veins, 96% (52/54) in internal mammary arteries and 100% (5/5) in gastroepiploic arteries. Relief of angina was noted in 58 (96.7%) of 60 survivors. It was concluded that the increase in the number of coronary artery anastomoses does not increase surgical risk and favorable outcome and acceptable graft patency can be obtained by multiple grafting for patients with severe multivessel coronary artery disease.