Thorac cardiovasc Surg
DOI: 10.1055/s-0037-1601306
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Coronary Artery Bypass Surgery in Diffuse Advanced Coronary Artery Disease: 1-Year Clinical and Angiographic Results

Luciana Oliveira Cascaes Dourado1, Marcio Sommer Bittencourt2, Alexandre Costa Pereira1, Nilson Tavares Poppi1, Luis Alberto Oliveira Dallan1, José Eduardo Krieger1, Luiz Antonio Machado Cesar1, Luís Henrique Wolff Gowdak1
  • 1Cardiopneumology department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
  • 2Division of Internal Medicine, Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
Further Information

Publication History

27 September 2016

18 February 2017

Publication Date:
29 March 2017 (eFirst)

Abstract

Background Proper treatment of patients with diffuse, severe coronary artery disease (CAD) is a challenge due to its complexity. Thus, data on the outcomes after coronary artery bypass graft (CABG) in this population is scarce. In this study, we aimed to determine the impact of CABG on the clinical and functional status, as well as graft patency in those individuals.

Methods Patients with severe and diffuse CAD who underwent incomplete CABG due to complex anatomy or extensive distal coronary involvement were evaluated preoperatively and 1 year after surgery. Postoperative coronary angiography was performed to evaluate graft patency. Graft occlusion was defined as the complete absence of opacification of the target vessel. Stratified analysis of graft occlusion was performed by graft type and territories, defined as left anterior descending artery (LAD), the left circumflex branch, and the right coronary artery territories; the latter two, grouped, were further classified as non-LAD territory.

Results A total of 57 patients were included, in whom 131 grafts were placed. There was a significant improvement in Canadian Cardiovascular Society angina symptom severity (Z = –6.1; p < 0.001) and maximum oxygen uptake (p < 0.001), with a corresponding decrease in the use of long-acting nitrates (p < 0.001). The overall graft occlusion rate was 19.1%, with no significant difference between LAD and non-LAD territories (p = 0.08). However, a significantly lower occlusion rate was noted for the internal mammary artery (IMA) grafts when compared with saphenous vein grafts (p = 0.01), though this difference was only significant in the LAD territory (p = 0.04). Overall, the use of venous graft was the only predictor occlusion at 1 year (odds ratio: 4.03; p = 0.016).

Conclusion In patients with diffuse CAD, incomplete CABG surgery resulted in a significant clinical improvement, with acceptable graft occlusion rates at 1 year, particularly for IMA grafts to the LAD territory.