Circulation, Vol 65, 90-97, Copyright © 1982 by American Heart Association
MG Bourassa, L Campeau, J Lesperance and CM Grondin
We studied the patency of saphenous vein aortocoronary bypass grafts in
nonconsecutive and consecutive subgroups of our first 600 patients. The
patency rates were 87-93% within 1 month and 74-85% approximately 1 year
after surgery. The attrition rate of grafts averaged 2.2% per year between
1 and 6 years. Early occlusion was due to thrombosis; occlusion at 1 year
was caused by fibrous intimal proliferation of grafts, which also led to
variable reduction in caliber and to significant (greater than 50%)
segmental stenoses in 5-15% of patent grafts. The most important
determinant of graft patency at 1 year was the runoff capacity of the
recipient arteries, followed by the quality of the surgical techniques.
Late occlusion was related to atherosclerosis that became manifest only
after at least 2 years. Coronary atherosclerosis progressed in more than
50% of proximal segments of grafted arteries during the first year, but
little additional deterioration occurred between 1 and 6 years. During the
first year, only 10% of preexisting stenoses in nongrafted arteries showed
progression of disease; progression in these vessels increased to 46% at 6
years and was no longer different, for preexisting lesions greater than
50%, from that of grafted arteries. A close correlation was observed
between changes in grafts and in coronary arteries and long-term survival
or relief of angina. Ninety-four percent of patients with all grafts patent
and 98% with an optimal correction were alive at 6 years compared with 70%
of patients without patent grafts or surgical correction. Changes in grafts
or coronary arteries were observed in two-thirds of patients in whom
functional deterioration occurred between 1 and 6 years, compared with 18%
in whom improvement persisted after surgery.
ARTICLES
Changes in grafts and coronary arteries after saphenous vein aortocoronary bypass surgery: results at repeat angiography
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