Heart Vessels DOI 10.1007/s00380-015-0715-8

ORIGINAL ARTICLE

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting Akihito Tanaka1 · Hideki Ishii1 · Hideki Oshima2 · Yohei Shibata1 · Yosuke Tatami1 · Naohiro Osugi1 · Tomoyuki Ota1 · Yoshihiro Kawamura1 · Susumu Suzuki1 · Akihiko Usui2 · Toyoaki Murohara1 

Received: 9 March 2015 / Accepted: 10 July 2015 © Springer Japan 2015

Abstract  Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the

* Akihito Tanaka [email protected] 1

Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai‑cho, Showa‑ku, Nagoya 466‑8550, Japan

2

Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan





proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts. Keywords  Coronary artery bypass grafting · Coronary angiography · Coronary artery disease

Introduction Coronary artery bypass grafting (CABG) has been established as a standard treatment for patients with complex coronary artery disease [1, 2]. CABG has comparative advantages, especially concerning its lower repeat revascularization rate. However, there is a wide range of variation in the types of target vessel failure after CABG or percutaneous coronary intervention (PCI), and this diversity has not been evaluated sufficiently. In daily practice, we occasionally encounter problematic situations after CABG, such as disease progression in the native coronary artery with bypass graft occlusion, which causes difficulty in revascularization (Fig. 1). Repeat revascularization in patients with target vessel failure after CABG is generally treated by PCI [1]. When the graft is occluded, PCI is usually performed for the native coronary artery opposed to the graft. If disease progression is not observed in the native coronary artery, then PCI for the native coronary vessel can be performed with equivalent risk and difficulty as observed preoperatively. On the contrary, if the proximal lesion in the native coronary artery progresses from ≤99 % stenosis to occlusion, then the difficulty and risk associated with PCI increase [3, 4], and longer stents are usually required. To date, little is known about changes in the native coronary artery after CABG. As described previously, in

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Heart Vessels

Fig. 1  A case with malignant graft failure: a patient underwent 2-vessel coronary artery bypass grafting with a left internal thoracic artery graft to the left anterior descending artery and an saphenous nein graft to the right coronary artery. a Preoperative angiography of the right coronary artery revealed severe stenosis at the proximal site in the right coronary artery. b, c Postoperative angiography 1 month after surgery revealed graft occlusion and progression from stenosis to occlusion in the proximal native coronary artery

patients with graft occlusion after CABG anastomosed to a non-occluded native vessel, the change in the native coronary artery proximal to the anastomosis site is important in clinical practice. When the graft occlusion involves disease progression from ≤99 % stenosis to occlusion in the native coronary artery proximal to the anastomosis site, we consider the event to be a malignant graft failure. The purpose of this study was to evaluate changes in the native coronary artery after CABG for a non-occluded coronary artery including the frequency of malignant graft failure.

Methods Between January 2009 and December 2012, 351 patients underwent isolated CABG or CABG and other cardiac procedures at Nagoya University Hospital, and 942 grafts were used. Of these, 768 grafts (332 patients) were anastomosed to vessels with ≤99 % preoperative proximal stenosis between the anastomosis site and aorta. Of the grafts for non-occluded vessels, early postoperative coronary graft angiography (

Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasi...
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