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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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ORIGINAL ARTICLES  CARDIAC SECTION


The Journal of Cardiovascular Surgery 2001 December;42(6):719-21

lingua: Inglese

Fate of bypass grafts onto totally occluded coronary arteries

Doss M., Hemmer W. *

From the Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery, Uni­ver­sity Frank­furt am ­Main
*Depart­ment of Car­diac Sur­gery Sana ­Clinic, Stutt­gart, Ger­many


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Back­ground. Chron­i­cally ­occluded cor­o­nary ­arteries ­often ­develop ­good col­lat­er­al­isa­tion, ­that ­leads to ret­ro­grade per­fu­sion of ­these ves­sels, as reg­u­larly ­seen in cor­o­nary angio­grams. Ret­ro­grade per­fu­sion con­sti­tutes a ­form of com­pet­e­tive ­flow, ­which in ­turn is asso­ciated ­with an ­increased ­risk for ­early ­bypass ­graft ­failure. The aim of our ­study is to inves­ti­gate the ­patency ­rate of ­bypass ­grafts ­onto ­totally ­occluded cor­o­nary ­arteries, in the pres­ence of ret­ro­grade ­flow.
­Methods. Two ­groups of ­patients ­were fol­lowed up by car­diac cath­et­er­isa­tion. One ­month ­after under­going cor­o­nary ­artery ­bypass ­grafting. ­Group 1 (n=33) had cor­o­nary ­three ­vessel dis­ease, ­with one ­totally ­occluded cor­o­nary ­artery and evi­dence of ret­ro­grade ­flow in the preoper­a­tive cor­o­nary angio­gram. ­Group 2 (n=30) was the con­trol ­group, ­with cor­o­nary ­three ­vessel dis­ease and ­without ­totally ­occluded cor­o­naries. We ­used ­internal mam­mary ­arteries and saph­e­nous ­vein ­grafts as con­duits.
­Results. Thirty-six point thirty-six per cent of ­bypass ­grafts ­onto ­totally ­occluded cor­o­naries ­were ­occluded one ­month post­op­er­a­tively (n=12). ­Graft ­failure in the con­trol ­group was 13.3%. Sig­nif­i­cance p=0.03.
Con­clu­sions. In ­view of our find­ings we con­clude, ­that ­there is a sig­nif­i­cantly ­increased inci­dence of ­early ­graft ­failure, ­when ­totally ­occluded cor­o­nary ­arteries are revas­cu­lar­ised, ­that ­show ret­ro­grade ­flow in the pre­op­er­a­tive cor­o­nary angio­gram.

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