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Multiple (more than eight) bypass grafts in severe diffuse coronary disease: improved exercise tolerance and
R G Sommerhaug1, S F Wolfe, D A Reid
1Thoracic and Cardiovascular Surgery, Concord, CA 94520.
Insights
Multiple coronary artery bypass grafting (CABG) for severe diffuse disease offers low mortality and improved patient outcomes. This extensive CABG approach significantly enhances functional classification and exercise tolerance in patients with complex coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Severe diffuse triple-vessel coronary artery disease presents significant therapeutic challenges.
- Traditional bypass grafting may not adequately address extensive coronary obstructions.
Purpose of the Study:
- To evaluate the safety and efficacy of multiple (eight or more) coronary artery bypass grafting (CABG) procedures.
- To assess outcomes in patients with severe diffuse coronary artery disease undergoing extensive CABG.
Main Methods:
- A consecutive series of 77 patients with severe diffuse triple-vessel coronary artery disease underwent multiple CABG (8-14 grafts) using saphenous vein conduits.
- Follow-up included survival rates, Canadian Cardiovascular Society Angina Criteria, and exercise testing (modified Bruce protocol).
Main Results:
- Operative mortality was low at 1.3%.
- Survival rate at a mean 2-year follow-up was 98.7% (76 of 77 patients).
- All post-operative patients improved to Canadian Cardiovascular Society Class I angina; 94% had normal exercise test results.
Conclusions:
- Multiple (eight or more) coronary artery bypass grafting is a viable option for severe diffuse coronary artery disease.
- This approach yields low mortality rates and significantly improves functional status and exercise tolerance.
Abstract:
During a 43-month period (May 1981 to December 1984), 77 consecutive patients underwent multiple (eight or more) coronary artery bypass procedures using saphenous vein conduits for severe diffuse triple-vessel coronary artery disease. Patients received from 8 to 14 grafts (average 9). All coronary arteries and branches that were at least 1.5 mm in diameter and greater than 50% obstructed were bypassed. The operative mortality rate was 1.3%. Seventy-six of 77 (98.7%) patients are alive at a mean follow-up of 2 years. According to the Canadian Cardiovascular Society Angina Criteria, before surgery 5 patients (6%) were classified class I, 8 (10%) class II, 43 (56%) class III, and 21 (27%) class IV. After surgery all 76 patients were class I. Of 59 patients who had undergone bypass surgery who were followed by exercise testing according to the modified Bruce protocol, 47 exercised to greater than or equal to 85% heart rate. Among these patients, 44 (94%) had a normal exercise test result and only 3 had greater than or equal to 1 mm ST segment depression. Thus, patients with severe diffuse coronary disease can undergo multiple (eight or more) bypass grafting procedures with low mortality rates and improved exercise tolerance and functional classification.