Long-Term Angiographic Results of Coronary Artery Bypass Surgery With The Use of Arterial Graft Combinations

Erhan Kaya, Denyan Mansuroğlu, Deniz Göksedef, Suat Nail Ömeroğlu, Mehmet Erdem Toker, Kaan Kırali, Mehmet Balkanay, Gökhan İpek, Cevat Yakut

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, İstanbul

Background: We examined the long-term results of coronary artery bypass surgery with the use of arterial graft combinations and evaluated the factors affecting graft patency.

Methods: Between 1996 and 2002, a total of 331 patients (320 men, 11 women; mean age 46.9±7.3 years; range 28 to 69 years) underwent surgery with the use of arterial graft combinations. The left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA) were used in 329, 192, and 147 patients respectively. In 281 patients, two arteries were used in combination (LIMA+RA in 178 patients, LIMA+RIMA in 103 patients). Complete arterial revascularization was performed in 182 patients (55%). The mean follow-up period was 45.3±25.5 months (range 1 to 113 months). To evaluate graft patency, control coronary angiographies were obtained in 105 patients (31.7%) after a mean of 46.6±30.3 months.

Results: Early mortality occurred in three patients (0.9%), and late mortality in seven patients (2.11%). Length of hospital stay (p=0.006) and frequency of wound infections (p=0.021) were significantly less in patients treated with complete arterial revascularization. Survival rates were 97.0±1.6% and 94.9±2.0% after a mean of 44 months and 64 months in patients treated with or without complete arterial revascularization, respectively (p=0.622). Survival did not differ significantly between LIMA+RIMA and LIMA+RA groups (p=0.261). On control angiographies, graft patency rates were 97.0% (96/99), 76.2% (48/63), 71.2% (37/52) and 64.6% (42/65) for LIMA, RA, RIMA, and saphenous vein groups, respectively. Occlusion of RA grafts was significantly associated with younger age (p=0.003) and the presence of diabetes mellitus (p=0.031).

Conclusion: Our results suggest that, among arterial grafts, the first choice can be made in favor of LIMA, combined with either RIMA or RA in coronary bypass operations.

Keywords : Coronary angiography; coronary artery bypass; coronary disease; internal mammary-coronary artery anastomosis; myocardial revascularization; radial artery; saphenous vein; vascular patency

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