Clinical significance, angiographic characteristics, and short-term outcomes in 30 patients with early coronary artery graft failure

Virani, Salim S.; Mm, Alam; Mendoza, Cesar E.; Arora, Hitesh; Ferreira, A. C.; Marchena, Eduardo de

doi:10.1007/bf03086209

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…It is not clear, however, what the clinical implications of asymptomatic graft failure are, as data from trials in which angiography is incorporated into the study protocol may demonstrate twice as much graft failure as that seen in angiography for symptoms [ 18 ]. The management of asymptomatic graft stenosis or occlusion remains contentious as graft PCI and re-do CABG carry higher risk burdens [ 19 ]. Conversely, progression of atherosclerosis in saphenous grafts is associated with increased risk for subsequent coronary events independent of symptoms [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Mid-term outcomes for Endoscopic versus Open Vein Harvest: a case control study

Kirmani

Barnard

Mourad

et al. 2010

J Cardiothorac Surg

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BackgroundSaphenous vein remains the most common conduit for coronary artery bypass grafting with increasing uptake of minimally invasive harvesting techniques. While Endoscopic Vein Harvest (EVH) has been demonstrated to improve early morbidity compared to Open Vein Harvest (OVH), recent literature suggests that this may be at the expense of graft patency at one year and survival at three years.MethodsWe undertook a retrospective single-centre, single-surgeon, case-control study of EVH (n = 89) and OVH (n = 182). The primary endpoint was death with secondary endpoints including acute coronary syndrome, revascularisation or other major adverse cardiac events. Freedom from angina, wound complications and self-rated health status were also assessed. Where repeat angiography had been performed, this was reviewed.ResultsBoth groups were well matched demographically and for peri-operative characteristics. All cause mortality was 2/89 (2%) and 11/182 (6%) in the EVH and OVH groups respectively. This was shown by Cox Log-Rank analysis to be non-significant (p = 0.65), even if adjusting for inpatient mortality (p = 0.74). There was no difference in the rates of freedom from angina (p = 1.00), re-admission (p = 0.78) or need for further anti-anginals (p = 1.00). There was a significant reduction in the incidence of leg wound infections and complications in the endoscopic group (EVH: 7%; OVH: 28%; p = 0.0008) and the skew of high patient self-rated health scores in the EVH group (61% compared to 52% in the open group) approached statistical significance (p = 0.06).ConclusionsWhile aware of the limitations of this small retrospective study, we are heartened by the preliminary results and consider our data to be justification for continuing to provide patients the opportunity to have minimally invasive conduit harvest in our centre. More robust evidence is still required to elucidate the implications of endoscopic techniques on conduit patency and patient outcome, but until the results of a large, prospective and randomised trial are available, we believe we can confidently offer our patients the option and benefits of EVH.

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Section: Discussionmentioning

confidence: 99%

Mid-term outcomes for Endoscopic versus Open Vein Harvest: a case control study

Kirmani

Barnard

Mourad

et al. 2010

J Cardiothorac Surg

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“…This includes new native coronary artery problems (ie, plaque rupture, thrombus), distal coronary microembolism, incomplete myocardial revascularization, inadequate myocardial protection, hypercoagulability, and preoperative severe ischemic injury. 4,7,9,11,16,19,20 In a prospective angiographic study of 1604 consecutive patients who underwent off-pump CABG, incomplete revascularization was reported in 13% and was associated with lower 5-year survival (75% vs 85%). 32 Notably, the incidence of nongraft-related causes of PMI is higher in patients undergoing combined surgical procedures where new native coronary artery occlusion was found in 20% and coronary artery spasm in 13% (5/40) of patients.…”

Section: Causes Of Perioperative Myocardial Ischemiamentioning

confidence: 99%

“…53 When anastomotic stenosis is identified, the culprit bypass graft is commonly the primary PCI target (although caution should be exercised when performing PCI on a recent anastomosis). 4,11 In cases of detected graft spasm during angiography, a catheter intervention with intragraft nitroglycerin injection can also be performed. 12 Recent guidelines recommend that redo CABG should be considered if the anatomy is unsuitable for PCI, if several important grafts are occluded, or in the case of obvious technical errors.…”

Section: Treatment Optionsmentioning

confidence: 99%

Postcardiac surgery myocardial ischemia: Why, when, and how to intervene

Robinson

Sef

Gaudino

et al. 2023

The Journal of Thoracic and Cardiovascular Surgery

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“…Both registries showed that patients with graft failure can undergo PCI with a relatively low risk for in-hospital mortality or nonfatal major complications. [143,144] SVG failure -Recurrent angina after the first few months after CABG is caused by both graft disease and by progression of atherosclerosis in non-bypassed vessels. Percutaneous intervention in SVG lesions was evaluated in several randomized studies.…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%