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A comparison of the results of A-C bypass grafting in collateral and non-collateral groups
Insights
Aorto-coronary bypass grafting showed improved outcomes in patients with collateral circulation. This collateral group experienced lower surgical mortality and better myocardial perfusion post-surgery compared to the non-collateral group.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Imaging
Background:
- Coronary artery disease (CAD) often involves stenosis or occlusion, necessitating surgical intervention like aorto-coronary bypass (ACB) grafting.
- The presence and significance of collateral circulation in patients undergoing ACB grafting remain an area of clinical interest.
- Assessing the impact of collateral pathways on surgical outcomes is crucial for patient management.
Purpose of the Study:
- To compare the outcomes of ACB grafting in patients with and without coronary collateral circulation.
- To evaluate the influence of collateral pathways on surgical mortality, graft patency, and myocardial function.
Main Methods:
- Ninety patients undergoing ACB grafting were categorized into collateral and non-collateral groups based on coronary angiogram (CAG) findings.
- Surgical mortality, graft patency, graft flow, left ventricular ejection fraction (LVEF), and myocardial perfusion (using thallium-201 scintigraphy) were assessed.
- Coronary arteries visualized via collateral circulation, including left anterior descending (LAD), right coronary arteries (RCA), and left circumflex arteries (LCX), were quantified.
Main Results:
- Surgical mortality was significantly lower in the collateral group (0%) compared to the non-collateral group (5.4%).
- While graft patency and flow did not differ significantly, the collateral group showed significant improvements in LVEF and myocardial perfusion post-ACB grafting.
- Coronary arteries identified through collateral vessels, initially appearing narrow, were found to be suitable for graft anastomosis.
Conclusions:
- ACB grafting yields more satisfactory results in patients with pre-existing collateral circulation.
- The presence of collateral circulation is associated with reduced surgical mortality and enhanced myocardial recovery after bypass surgery.
- Collateral pathways, even if seemingly small, can be effectively utilized for bypass grafting, improving cardiac function.
Abstract:
Ninety patients who had aorto-coronary bypass grafting were divided into two groups: a collateral group, which had coronary arterial stenosis or occlusion with collateral circulation, and a non-collateral group, which had coronary arterial stenosis or occlusion without collateral circulation. The number of coronary arteries visualized through collateral circulation in coronary angiograms (CAG) was 32, left anterior descending arteries (LAD) 17, right coronary arteries (RCA) 11, and left circumflex arteries (LCX) 4. The results of A-C bypass grafting in the collateral and non-collateral groups were compared. Surgical mortality was 0% in the collateral group, and 5.4% in the non-collateral group. The differences in graft patency and graft flow between the two groups were not statistically significant. However, left ventricular ejection fraction and myocardial perfusion, which was estimated by thallium-201 myocardial perfusion scintigram, were significantly improved after A-C bypass in the collateral group. Although the coronary arteries visualized through collateral vessels seemed too narrow to undergo graft anastomosis, they were, in fact, large enough. A-C bypass grafting was achieved with more satisfactory results in the collateral group than in the non-collateral group.