Native Coronary Artery Patency After Coronary Artery Bypass Surgery

Pereg, David; Fefer, Paul; Samuel, Michelle; Wolff, Rafael; Czarnecki, Andrew; Deb, Saswata; Sparkes, John D.; Fremes, Stephen E.; Strauss, Bradley H.

doi:10.1016/j.jcin.2014.01.164

Cited by 68 publications

(50 citation statements)

References 28 publications

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“…2 Second, CABG by itself escalates progression of atherosclerosis or thrombosis in bypassed native coronary arteries 3 ; 43% of bypassed native coronary arteries will develop chronic total occlusions (CTOs) as early as 1 year after CABG. 4 As a result, the prevalence of native artery CTO in patients undergoing coronary angiography reaches 54% in the post-CABG population, higher than in patients without CABG. 5 In summary, when SVGs become diseased or occluded, the whole native coronary tree has sustained substantial changes and has become more difficult to treat.…”

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confidence: 99%

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Dautov

Nguyen

Altisent

et al. 2016

Circ: Cardiovascular Interventions

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Background-The prevalence of native coronary chronic total occlusions (CTOs) after coronary artery bypass grafts (CABGs) is higher than in non-CABG population. We examined outcomes of CTO percutaneous coronary intervention (PCI) post-CABG versus without CABG. Then, we looked at feasibility and outcomes of retrograde CTO PCI via patent or occluded saphenous vein graft. Methods and Results-We compared patient and procedural characteristics of 470 CTO cases treated from January 2010 to December 2015 depending on history of CABG. We assessed major adverse cardiac events, including cardiac death, myocardial infarction, ischemia-driven target-vessel revascularization, or reocclusion 1 year after successful CTO PCI in patients treated before February 2015. Post-CABG patients (175 cases) had a higher J-CTO score (2.5 versus 2.1; P=0.002). In-hospital complications were similar, although the incidence of contrast-induced nephropathy was higher in post-CABG patients (4.6% versus 1%; P=0.01). With multivariable analysis, post-CABG status was associated with higher incidence of 1-year major adverse cardiac event (hazards ratio=2.2; P=0.02). As a second level analysis, we looked at the feasibility and safety of CTO PCI via saphenous vein grafts (19% of post-CABG cases) versus collateral channels (36%) versus with an antegrade-only approach (45%), and assessed short-term outcomes and complications. High success was achieved in the saphenous vein graft group. In-hospital events were similar in the 3 groups. Conclusions-Post-CABG CTO PCI is associated with similar high success and low complications compared with CTO PCI in patients who never had CABG. However, it is associated with higher recurrent events at 1 year. To achieve high success rate, use of saphenous vein grafts as retrograde conduits seems to be safe and effective. (Circ Cardiovasc Interv. 2016;9:e003515.

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confidence: 99%

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Dautov

Nguyen

Altisent

et al. 2016

Circ: Cardiovascular Interventions

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“…The presence of a bypass graft is associated with accelerated atherosclerotic disease process and greater risk of development of a CTO of a bypassed vessel. 23) Early studies indicated that patients with occluded bypass grafts were able to recruit the same degree of collaterals as prior to the surgery, 24,25) although other series have suggested that the ability to recruit collaterals to the bypassed vessel is reduced. 26) As we excluded patients who had a previous bypass to the occluded vessel, the presence of a CABG itself appears to negatively impact on the collateral circulations' ability to spontaneously mature.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

et al. 2020

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The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and to determine its effects on procedural outcomes and prognosis. Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified. A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality. Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.

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“…It is well known in the literature, that the worsening of native bypassed stenosis (until occlusion) on grafted vessels after CABG is a common occurrence. Mainly, it seems to be related to blood flow alterations and shear stress carried out by the grafts themselves, along with cardiovascular risk factors (7,8).…”

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A thoughtful use of CT angiography among patients with prior coronary artery bypass grafts: more lights than shadows?

Barbero

Iannaccone

Barbero

et al. 2017

Cardiovasc. Diagn. Ther.

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Native Coronary Artery Patency After Coronary Artery Bypass Surgery

Abstract: CTO of surgically bypassed coronary arteries 1 year after coronary artery bypass grafting is extremely common.

Cited by 68 publications

References 28 publications

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Recanalization of Chronic Total Occlusions in Patients With Previous Coronary Bypass Surgery and Consideration of Retrograde Access via Saphenous Vein Grafts

Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic Total Occlusion (CTO)

A thoughtful use of CT angiography among patients with prior coronary artery bypass grafts: more lights than shadows?

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