Coronary bypass graft fate: long-term angiographic study

Cardio-Pulmonary Unit, National Defence Medical Centre, Ottawa, Ontario, Canada.

In 222 patients, 741 venous coronary bypass grafts were studied angiographically early, at 1 year and at a late examination at greater than 6.5 years (mean 9.6) after operation; 565 of these grafts were also examined 5 years postoperatively. Grafts were graded for patency and disease considered to be atherosclerotic and for both extent and profile of lesions. Graft occlusion rates increased steadily from 8% early to 20% at 5, 41% at 10 and 45% at greater than 11.5 years after operation. All grafts were considered free of atherosclerosis early, but disease appeared in 8% at 1 year, increasing to 38% at 5 and 75% at 10 years postoperatively. Increasing involvement of vessel wall area was associated with greater protrusion of lesions into the graft lumen. Diseased grafts became more so at subsequent examinations, with occlusion occurring in many. However, absence of disease had little prognostic significance because diseased and abruptly occluded grafts were generated in those with healthy appearance at earlier examinations. For instance, 82% of very diseased grafts at the 5 year study originated from normal grafts at 1 year and 73% of occluded grafts at 1 year had appeared normal early postoperatively. Of 590 patent grafts free of disease at 1 year, 30% were occluded at the late examination, 76% of those patent were diseased, 55% of these were diffusely diseased and 35% were greater than 50% narrowed. Only 17% of the original 590 patent grafts were healthy at this time. Bypass graft atherosclerosis severely limits the long-term utility of these grafts. It is suggested that the solution may lie in some powerful drug regimen.

This article has been cited by other articles:

				G. Cooper 16.13.7 Coronary artery bypass surgery OTM, November 30, 2011; 5(1): med-9780199204854-chapter - med-9780199204854-chapter. [Abstract] [Full Text]

				P. Human, T. Franz, J. Scherman, L. Moodley, and P. Zilla Dimensional analysis of human saphenous vein grafts: Implications for external mesh support. J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1101 - 1108. [Abstract] [Full Text] [PDF]

				B. F. Buxton, P. A. R. Hayward, A. E. Newcomb, S. Moten, S. Seevanayagam, and I. Gordon Choice of conduits for coronary artery bypass grafting: craft or science? Eur J Cardiothorac Surg, April 1, 2009; 35(4): 658 - 670. [Abstract] [Full Text] [PDF]

				G. V. Gonzalez-Stawinski and B. W. Lytle Coronary Artery Reoperations Card. Surg. Adult, January 1, 2008; 3(2008): 711 - 732. [Full Text]

				R. Hoffmann, T. Pohl, R. Koster, R. Blindt, P. Boeckstegers, and T. Heitzer Implantation of paclitaxel-eluting stents in saphenous vein grafts: clinical and angiographic follow-up results from a multicentre study Heart, March 1, 2007; 93(3): 331 - 334. [Abstract] [Full Text] [PDF]

				C. M. Jones, T. Athanasiou, N. Dunne, J. Kirby, O. Aziz, A. Haq, C. Rao, V. Constantinides, S. Purkayastha, and A. Darzi Multi-Detector Computed Tomography in Coronary Artery Bypass Graft Assessment: A Meta-Analysis Ann. Thorac. Surg., January 1, 2007; 83(1): 341 - 348. [Abstract] [Full Text] [PDF]

				K. R. Cho, J.-S. Kim, C. Jae-Sung, and K.-B. Kim Serial angiographic follow-up of grafts one year and five years after coronary artery bypass surgery Eur J Cardiothorac Surg, April 1, 2006; 29(4): 511 - 516. [Full Text] [PDF]

				J. Kaehler, R. Koester, W. Billmann, C. Schroeder, H.-J. Rupprecht, T. Ischinger, R. Jahns, A. Vogt, M. Lampen, R. Hoffmann, et al. 13-year follow-up of the German angioplasty bypass surgery investigation Eur. Heart J., October 2, 2005; 26(20): 2148 - 2153. [Abstract] [Full Text] [PDF]

				G. P. Georghiou, B. A. Vidne, and J. Dunning Does the radial artery provide better long-term patency than the saphenous vein? Interact CardioVasc Thorac Surg, August 1, 2005; 4(4): 304 - 310. [Abstract] [Full Text] [PDF]

				V. Schachinger, C. W. Hamm, T. Munzel, M. Haude, S. Baldus, E. Grube, T. Bonzel, T. Konorza, R. Koster, R. Arnold, et al. A randomized trial of polytetrafluoroethylene-membrane-covered stents compared with conventional stents in aortocoronary saphenous vein grafts J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1360 - 1369. [Abstract] [Full Text] [PDF]

				M. Brueck, W. Kramer, P. R. Vogt, W. G. Daniel, H. Tillmanns, and J. Ludwig Patency rates of three arterial grafting patterns to the left anterior descending and diagonal coronary arteries in symptomatic patients Ann. Thorac. Surg., April 1, 2003; 75(4): 1161 - 1164. [Abstract] [Full Text] [PDF]

				B. Markl, S. Raab, H. Arnholdt, and C. Vicol Morphological and histopathological comparison of left and right internal thoracic artery with implications on their use for coronary surgery Interact CardioVasc Thorac Surg, March 1, 2003; 2(1): 73 - 76. [Abstract] [Full Text] [PDF]

				B. W. Lytle Coronary Artery Reoperations Card. Surg. Adult, January 1, 2003; 2(2003): 659 - 679. [Full Text]

				E. C. Keeley, C. A. Velez, W. W. O'Neill, and R. D. Safian Long-term clinical outcome and predictors of major adverse cardiac events after percutaneous interventions on saphenous vein grafts J. Am. Coll. Cardiol., September 1, 2001; 38(3): 659 - 665. [Abstract] [Full Text] [PDF]

				R. Dion, D. Glineur, D. Derouck, R. Verhelst, P. Noirhomme, G. El Khoury, E. Degrave, and C. Hanet Complementary saphenous grafting: Long-term follow-up J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 296 - 304. [Abstract] [Full Text] [PDF]

				S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]

				U E Heidland, M P Heintzen, C J Michel, and B E Strauer Risk factors for the development of restenosis following stent implantation of venous bypass grafts Heart, March 1, 2001; 85(3): 312 - 317. [Abstract] [Full Text]

				S. E. Langerak, P. Kunz, H. W. Vliegen, H. J. Lamb, J. W. Jukema, E. E. van der Wall, and A. de Roos Improved MR Flow Mapping in Coronary Artery Bypass Grafts during Adenosine-induced Stress Radiology, February 1, 2001; 218(2): 540 - 547. [Abstract] [Full Text]

				M. J. Zellweger, H. C. Lewin, S. Lai, E. A. Dubois, J. D. Friedman, G. Germano, X. Kang, T. Sharir, and D. S. Berman When to stress patients after coronary artery bypass surgery?: Risk stratification in patients early and late post-CABG using stress myocardial perfusion SPECT: implications of apppropriate clinical strategies J. Am. Coll. Cardiol., January 1, 2001; 37(1): 144 - 152. [Abstract] [Full Text] [PDF]

				S. Baldus, R. Koster, M. Elsner, D. H. Walter, R. Arnold, W. Auch-Schwelk, J. Berger, M. Rau, T. Meinertz, A. M. Zeiher, et al. Treatment of Aortocoronary Vein Graft Lesions With Membrane-Covered Stents : A Multicenter Surveillance Trial Circulation, October 24, 2000; 102(17): 2024 - 2027. [Abstract] [Full Text] [PDF]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]

				C. Bartels, M. Maass, G. Bein, R. Malisius, N. Brill, J. F. M. Bechtel, F. Sayk, A. C. Feller, and H.-H. Sievers Detection of Chlamydia pneumoniae But Not Cytomegalovirus in Occluded Saphenous Vein Coronary Artery Bypass Grafts Circulation, February 23, 1999; 99(7): 879 - 882. [Abstract] [Full Text] [PDF]

				H. I. Manninen, P. Jaakkola, M. Suhonen, S. Rehnberg, R. Vuorenniemi, and P. J. Matsi Angiographic predictors of graft patency and disease progression after coronary artery bypass grafting with arterial and venous grafts Ann. Thorac. Surg., October 1, 1998; 66(4): 1289 - 1294. [Abstract] [Full Text] [PDF]

				D P TAGGART Arterial or venous conduits for redo coronary artery bypass grafting? Heart, July 1, 1998; 80(1): 1 - 2. [Full Text]

				S. S. Kushwaha, M. Bustami, S. Tadjkarimi, C. D. J. Ilsley, A. G. Mitchell, and M. H. Yacoub LATE ENDOTHELIAL FUNCTION OF FREE AND PEDICLED INTERNAL MAMMARY ARTERY GRAFTS J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 453 - 462. [Abstract] [Full Text]

				S. E. Langerak, P. Kunz, H. W. Vliegen, J. W. Jukema, A. H. Zwinderman, P. Steendijk, H. J. Lamb, E. E. van der Wall, and A. de Roos MR Flow Mapping in Coronary Artery Bypass Grafts: A Validation Study with Doppler Flow Measurements Radiology, January 1, 2002; 222(1): 127 - 135. [Abstract] [Full Text] [PDF]