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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 2001 Aprile;42(2):159-64

lingua: Inglese

Effect of coronary artery bypass grafting on native coronary artery stenosis. Comparison of internal thoracic artery and saphenous vein grafts

Hamada Y., Kawachi K., Yamamoto T., Nakata T., Kashu Y., Watanabe Y., Sato M.

From the Depart­ment of Sur­gery II, ­Ehime Uni­ver­sity ­School of Med­i­cine, ­Eime, ­Japan


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Back­ground. The pur­pose of ­this ­study was to inves­ti­gate the influ­ence of cor­o­nary ­artery ­bypass ­grafting on the ­degree of sten­osis of the ­native cor­o­nary ­artery.
­Methods. Experi­mental ­design: ret­ro­spec­tive ­data anal­ysis. Set­ting: Uni­ver­sity hos­pital. ­Patients: con­sec­u­tive ­patients under­going cor­o­nary ­artery ­bypass ­grafting (n=52). ­Bypasses ­using ­internal tho­racic ­artery ­grafts (n=26) and saph­e­nous ­vein ­grafts (n=37) to incom­pletely ­occluded cor­o­nary ­arteries ­were ­studied. Inter­ven­tions: cor­o­nary ­artery ­bypass ­grafting ­using ­internal tho­racic ­artery or saph­e­nous ­vein ­grafts. Meas­ures: sten­osis of the ­native cor­o­nary ­artery on angio­graphy.
­Results. ­Three recip­ient cor­o­nary ­arteries ­bypassed ­with ­internal tho­racic ­artery ­grafts (12%) and 14 recip­ient cor­o­nary ­arteries ­bypassed ­with saph­e­nous ­vein ­grafts (38%) ­showed pro­gres­sion of nar­rowing (p=0.024). Two recip­ient cor­o­nary ­arteries ­bypassed ­with ­internal tho­racic ­artery ­grafts (8%) and 13 recip­ient cor­o­nary ­arteries ­bypassed ­with saph­e­nous ­vein ­grafts (35%) ­showed ­total occlu­sion (p=0.016). Hyper­ten­sion, hyper­lip­i­demia, dia­betes mel­litus, and ­smoking his­tory did not cor­re­late ­with pro­gres­sion of sten­osis of the ­native cor­o­nary ­arteries. ­Graft ­flow meas­ured ­during sur­gery in the saph­e­nous ­vein ­grafts was not sig­nif­i­cantly dif­ferent ­between the ­group ­that exhib­ited pro­gres­sion of the ­native sten­osis and the ­group ­that did not.
Con­clu­sions. Cor­o­nary ­artery ­bypass ­grafting ­with saph­e­nous ­vein ­grafts may ­result in pro­gres­sion of sten­osis of the recip­ient cor­o­nary ­artery. ­This is ­less ­likely ­after cor­o­nary ­artery ­bypass ­grafting ­with ­internal tho­racic ­artery ­grafts. ­This dif­fer­ence may be due to the ­ability of the ped­i­cled ­internal tho­racic ­artery ­graft to reg­u­late ­flow. ­Thus com­pet­i­tive ­flow in the ­native cor­o­nary ­artery is min­i­mized. ­This has sig­nif­i­cant clin­ical impli­ca­tions.

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