Related Experiment Videos
How serious is a proximal occlusion of a posterolateral sequential bypass?
J T Christenson1, M Schmuziger
1Cardiovascular Surgery Unit, Hôpital de la Toul, Meyrin-Geneva, Switzerland.
Insights
Proximal occlusion of posterolateral sequential bypass grafts is rare, with low risk of heart attack or death. This finding is crucial for coronary artery bypass grafting outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiac Surgery
Background:
- Sequential coronary bypass grafting offers benefits but faces criticism regarding reliance on a single proximal anastomosis.
- Concerns exist about the vulnerability of proximal anastomoses in sequential grafts.
Purpose of the Study:
- To evaluate the risk associated with proximal occlusion of posterolateral sequential bypass grafts.
- To assess the clinical impact and management of such occlusions.
Main Methods:
- Retrospective analysis of 3,203 patients undergoing coronary artery bypass grafting with sequential vein grafts between 1984 and 1994.
- Detailed follow-up of 3,130 survivors, analyzing graft patency and symptomatic occlusions.
- Specific focus on posterolateral sequential grafts and their proximal anastomoses.
Main Results:
- Out of 5,626 sequential grafts, 3,492 were posterolateral. Symptomatic occlusion occurred in 8.0% of all sequential grafts.
- Proximal occlusion of posterolateral sequential grafts was rare (0.7%), occurring at 35.9 months post-surgery.
- These rare occlusions led to angina or myocardial infarction in 23 patients, with no associated mortality.
Conclusions:
- Symptomatic proximal occlusion of posterolateral sequential bypass grafts is an infrequent complication.
- The risk of myocardial infarction and mortality is low, especially when the distal anastomosis is to a high-flow vessel.
- Successful revascularization is achievable, with a 10-year survival rate of 86.7%.
Abstract:
The sequential coronary bypass, despite having several demonstrated benefits, has been criticized for being solely dependent upon 1 proximal anastomosis. The aim of this study was to evaluate the danger of a proximal occlusion of a posterolateral sequential bypass graft. Between 1 January 1984 and 31 December 1994, 3,203 patients underwent primary coronary artery bypass grafting with at least 1 sequential vein bypass graft (780 patients received 1 sequential graft and 2,423 patients received 2). There were 5,626 sequential bypass grafts: 3,492 posterolateral (62%) and 2,134 antero-latero-septal (38%) grafts. There were 73 hospital deaths (2.3%). Follow-up was performed on 3,130 hospital survivors (5,504 grafts), for an average of 59 +/- 36 months (range, 1 to 11 years). During follow-up, a total of 250 symptomatic sequential graft occlusions occurred in 250 patients (8.0%). Only 23 (0.7%) of the surviving 3,431 posterolateral sequential bypass grafts had symptomatic proximal occlusion, 35.9 +/- 5.9 months postoperatively, with all the distal anastomoses remaining patent. Twenty-two of the patients so affected presented with angina and 1 with myocardial infarction. There was no mortality. In 12 patients (52%), medical treatment was sufficient, while 11 patients (48%) underwent successful repeat coronary revascularization. The operation consisted of a simple vein graft from the aorta to the distally patent sequential graft in all patients. Four patients had additional coronary artery bypass grafting due to progression of the disease. The 10-year survival rate was 86.7%. Symptomatic occlusion of only the proximal segment of posterolateral sequential bypass grafts occurs rarely and has a low risk of myocardial infarction and mortality, provided that the terminal anastomosis is with a high-flow vessel.