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Evaluation of coronary revascularization for ischemic heart disease: in the consecutive 200 cases
Insights
Coronary revascularization showed no operative deaths in the second 100 patients, even with high-risk factors. Long-term follow-up revealed improved exercise tolerance and high graft patency rates.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary revascularization is increasingly performed in older patients with significant comorbidities.
- Assessing outcomes in this high-risk population is crucial for surgical decision-making.
Purpose of the Study:
- To evaluate the safety and efficacy of elective simple coronary revascularization in a consecutive patient cohort.
- To analyze perioperative and long-term outcomes, including mortality, graft patency, and functional status.
Main Methods:
- Retrospective analysis of 200 consecutive patients undergoing elective simple coronary revascularization.
- Inclusion of patients with high-risk factors such as low left ventricular ejection fraction (LVEF) and multi-vessel disease.
- Assessment of perioperative outcomes, 7-year survival, graft patency, and exercise tolerance.
Main Results:
- No operative deaths occurred in the second 100 patients, compared to the first 100.
- Calcium antagonists effectively managed spastic angina perioperatively.
- No cardiac deaths were observed during the 7-year follow-up.
- Improved exercise tolerance was noted, even in patients with preoperative low LVEF.
- Graft patency rates were 92% at an average follow-up of 11 months for both saphenous vein grafts and internal mammary artery grafts (IMAG).
Conclusions:
- Elective simple coronary revascularization is a safe procedure with excellent long-term outcomes, even in high-risk patients.
- Internal mammary artery grafts demonstrate comparable patency and flow characteristics to saphenous vein grafts.
- Management of comorbidities like hyperlipidemia and diabetes is essential for preventing graft occlusion and disease progression.
Abstract:
The elective simple coronary revascularization in the last consecutive 200 patients were analyzed in this study. Despite of the increase in older patients who have more high risk factors, including low left ventricular ejection fraction (LVEF) and multiple vessel disease, there were no operative deaths in the second 100 patients. The use of calcium antagonist in patients with a history of spastic angina eliminated episodes of spastic angina in the perioperative period. In the late postoperative period, there were no cardiac deaths during the 7-year follow-up period. Angina remained in two of three patients with the patent grafts, who had a history of spastic angina. Hyperlipidemia and diabetes mellitus influenced occlusion of the grafts and progression of atherosclerosis of native coronary arteries and then four of five reoperations. Exercise tolerance in patients, even those with preoperative low LVEF, has been improved although their was some increment of left ventricular end-diastolic pressure during exercise. Patency rate in sequential grafting with saphenous vein grafts or internal mammary artery grafts were 92% in the average follow-up period of 11 months. The increase of flow rate with nitroglycerine and atrial pacing in internal mammary artery grafts (IMAG) were comparable with saphenous vein grafts.