Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results
Luciana Oliveira Cascaes Dourado1, Marcio Sommer Bittencourt2, Alexandre Costa Pereira1
1Cardiopneumology department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Insights
Coronary artery bypass graft (CABG) surgery for diffuse coronary artery disease (CAD) significantly improves patient symptoms and function. Internal mammary artery grafts show better patency than saphenous vein grafts, especially in the left anterior descending artery territory.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Diffuse, severe coronary artery disease (CAD) presents complex treatment challenges.
- Limited data exists on the outcomes of coronary artery bypass graft (CABG) surgery in this patient population.
- Understanding the impact of CABG on clinical status and graft patency is crucial.
Purpose of the Study:
- To evaluate the clinical and functional outcomes of CABG in patients with severe, diffuse CAD.
- To assess graft patency one year after incomplete CABG surgery.
- To identify predictors of graft occlusion in this cohort.
Main Methods:
- Retrospective analysis of 57 patients with severe, diffuse CAD undergoing incomplete CABG.
- Preoperative and 1-year postoperative assessment of clinical and functional status.
- Postoperative coronary angiography to determine graft patency and occlusion rates.
- Stratified analysis of graft occlusion by graft type (internal mammary artery vs. saphenous vein) and coronary territory (LAD vs. non-LAD).
Main Results:
- Significant improvements observed in angina symptom severity (CCS class) and maximum oxygen uptake one year post-CABG.
- Overall graft occlusion rate was 19.1% at one year.
- Internal mammary artery (IMA) grafts demonstrated significantly lower occlusion rates compared to saphenous vein grafts (SVG).
- SVG use was identified as the sole predictor of graft occlusion at one year.
Conclusions:
- Incomplete CABG surgery offers significant clinical benefits for patients with diffuse CAD.
- Graft occlusion rates at one year are acceptable, particularly with IMA grafts to the LAD territory.
- IMA grafts are superior to SVG in maintaining patency in this complex patient group.
Background:
Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals.
Methods:
Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1 year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory.
Results:
A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = -6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016).
Conclusion:
In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.
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