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Published on: August 28, 2018
Early silent coronary bypass graft occlusion following coronary bypass surgery, implication of routine coronary
Islam Salikhanov1, Luca Koechlin1, Brigitta Gahl1
1Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Insights
Early bypass graft occlusion after coronary bypass surgery is linked to surgical duration and complexity. Prolonged procedures increase the risk of graft failure, highlighting the importance of surgical efficiency in CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Radiology
- Medical Imaging
Background:
- Coronary artery bypass grafting (CABG) remains a cornerstone treatment for severe coronary artery disease.
- Early detection of bypass graft occlusion is crucial for patient outcomes.
- Cardiac computed tomography angiography (CCTA) offers detailed visualization of bypass grafts.
Purpose of the Study:
- To determine the incidence of early silent bypass graft occlusion following CABG.
- To identify predictors of early graft occlusion using CCTA.
- To analyze the association between surgical factors and graft patency.
Main Methods:
- A prospective study of 439 patients undergoing isolated CABG.
- Graft patency assessed by CCTA before hospital discharge, evaluating 1,319 anastomoses.
- Univariable and multivariable logistic regression analyses performed to identify predictors of occlusion.
Main Results:
- Overall incidence of graft occlusion was 2.4%, affecting 6.6% of patients.
- No significant difference in occlusion rates between arterial (2.1%) and vein (2.6%) grafts.
- Increased duration of surgery (p=0.034) and cross-clamp time (p=0.024) were significantly associated with graft occlusion.
Conclusions:
- Early graft occlusion is associated with surgical factors, particularly prolonged intervention duration.
- The number of distal anastomoses and overall surgical time are significant predictors of early graft occlusion (EGO).
- Longer procedural times, reflecting complex coronary pathology, correlate with an elevated risk of bypass graft occlusion.
Objective:
To evaluate incidence and predictors of early silent bypass occlusion following coronary bypass surgery using cardiac computed tomography angiography.
Methods:
A total of 439 consecutive patients with mean age of 66 ± 10 years comprising 17% (n = 75) females underwent isolated coronary bypass surgery followed by CT scan before discharge. Graft patency was evaluated in 1,319 anastomoses where 44% (n = 580) arterial and 56% (n = 739) vein graft anastomosis were performed. Cardiovascular risk factors, demographics, and intraoperative variables were analyzed. We conducted univariable and multivariable logistic regression analyses to analyze variables potentially associated with graft occlusion following CABG. Variables included gender, surgery duration, graft flow, pulsatility index, vein vs. artery graft, and recent MI.
Results:
Overall incidence of graft occlusion was 2.4% (31/1,319), and it was diagnosed in 6.6% (29/439) of patients. The difference in occlusion between arterial (2.1%) and vein (2.6%) grafts was not significant, p = 0.68. The duration of intervention p = 0.034, cross clamp time p = 0.024 as well the number of distal anastomosis p = 0.034 were significantly higher in occlusion group. The univariate and multivariate logistic regression indicated duration of surgery being predictive for bypass graft occlusion with OR = 1.18; 95% CI: 1.01-1.38; p = 0.035.
Conclusions:
Early graft occlusion was associated with surgical factors. The number of distant anastamoses, along duration of surgical intervention were, significantly influenced the risk of EGO. Prolonged procedural time reflecting complex coronary pathology and time-consuming revascularization procedure was as well associated to the elevated risk of occlusion.
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