From a Position of Known Angiographic Perfect Patency: What Happens Next?

Area of Science:

• Cardiovascular Surgery
• Vascular Biology
• Interventional Cardiology

Background:

• Coronary artery bypass grafting (CABG) relies on graft conduits to restore blood flow.
• The long-term biological behavior and patency of different graft types are crucial for patient outcomes.
• Serial angiography is a key tool for evaluating graft performance over time.

Purpose of the Study:

• To compare the long-term patency of internal mammary arteries, radial arteries, and saphenous veins used as coronary grafts.
• To assess the durability of perfectly patent grafts in the years following coronary bypass surgery.

Main Methods:

• Retrospective analysis of clinically indicated angiograms from 1997-2020 in patients post-CABG.
• Selection of grafts with perfect patency on initial postoperative angiography.
• Comparison of initial and latest angiograms (≥5 years postoperatively) to evaluate graft patency changes.
• Statistical analysis using generalized estimating equations and logistic regression.

Main Results:

• Internal mammary arteries (99.4%) and radial arteries (99.6%) maintained excellent patency at long-term follow-up (12.2±3.8 years).
• Saphenous vein grafts demonstrated significantly lower patency rates (52.0%) at long-term follow-up.
• Arterial grafts (internal mammary and radial) were significantly superior to vein grafts (OR 163, p<0.001).

Conclusions:

• Internal mammary artery and radial artery grafts exhibit superior long-term patency after CABG compared to saphenous vein grafts.
• Perfectly patent arterial grafts maintain their patency exceptionally well over extended periods.
• Saphenous vein grafts are prone to significant deterioration, impacting their long-term efficacy.