Coronary artery bypass graft disease
1Division of Cardiology, Harris Chasanoff Heart Institute, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA.
Insights
Saphenous vein graft disease is common after coronary artery bypass grafting, with 50% closing within 10 years. Using arterial grafts, like the internal mammary artery, significantly improves graft patency and patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Medical Technology
Background:
- Saphenous vein grafts are frequently used in coronary artery bypass grafting (CABG).
- Vein grafts are susceptible to occlusive disease, primarily atherosclerosis, leading to graft failure.
- Graft closure results in symptom recurrence and reduced long-term patient benefit.
Purpose of the Study:
- To review the incidence and pathophysiology of saphenous vein graft disease.
- To evaluate current strategies for the prevention of vein graft disease.
- To discuss management options for failing saphenous vein grafts.
Main Methods:
- Comprehensive literature search of MEDLINE database for studies on saphenous vein and arterial bypass grafts.
- Focused selection of key studies from reference sections of relevant articles.
- Extraction and synthesis of key findings related to graft outcomes and disease processes.
Main Results:
- Saphenous vein graft failure is high, with 50% occlusion by 10 years post-CABG due to atherosclerosis.
- Internal mammary artery grafts demonstrate superior patency rates (90% at >10 years) and are resistant to atherosclerosis.
- Arterial grafts offer significant clinical advantages, including symptom relief, improved cardiac function, and increased survival.
Conclusions:
- Prioritizing arterial grafts, such as the internal mammary artery, is crucial for preventing vein graft disease.
- Minimizing endothelial injury during surgery and utilizing antiplatelet agents can reduce vein graft occlusion.
- Reoperation for diseased grafts, particularly to the left anterior descending artery, can improve survival when arterial grafts are used.
Purpose:
To review saphenous vein graft disease and its prevention and management.
Data Sources:
A MEDLINE search of articles published on saphenous vein and arterial bypass grafts.
Study Selection:
The reference sections of articles focused the selection of key studies.
Data Extraction:
Relevant data representing key findings were noted.
Data Synthesis:
The outcome of coronary artery bypass grafting with the saphenous vein graft is unsatisfactory because vein grafts are prone to occlusive disease. By 10 years after surgery, 50% have closed, mainly because of atherosclerosis. With vein graft disease and graft closure, symptoms return. The best way to prevent vein graft disease is to use the internal mammary artery graft. This has become the preferred graft because it is not affected by atherosclerosis. Consequently, it has a much higher patency rate: 90% after more than 10 years. This provides such clinical benefits as decreased occurrence of symptoms, better left ventricular performance, decreased need for reoperation, and prolongation of life. The limited supply of mammary arteries has stimulated interest in identifying alternative arterial grafts.
Conclusions:
To prevent vein graft disease, surgeons should bypass diseased coronary arteries with at least one arterial graft and take measures during the surgery to avoid endothelial injury to vein grafts. Treatment with antiplatelet agents decreases the vein graft occlusion rate. When graft atherosclerosis causes symptoms, reoperation will probably prolong life if an old graft to the left anterior descending coronary artery is diseased. Reoperation increases a patient's chance for survival if the surgeon uses at least one arterial graft.
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