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J Thorac Cardiovasc Surg 2008;135:300-307
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Midterm angiographic follow-up after off-pump coronary artery bypass: Serial comparison using early, 1-year, and 5-year postoperative angiograms

^a Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
^b Department of Thoracic and Cardiovascular Surgery, Halla General Hospital, Jeju-City, Jeju-Do, Korea

Received for publication May 2, 2007; revisions received August 30, 2007; accepted for publication September 11, 2007.

^_* Address for reprints: Ki-Bong Kim, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. (Email: kimkb{at}snu.ac.kr).

Objective: We analyzed the angiographic changes of the anastomotic sites at three time points for 5 years after off-pump coronary artery bypass surgery.

Methods: Of the 402 patients who underwent off-pump coronary artery bypass surgery between January 1998 and December 2001, 240 patients who received the early, 1-year, and 5-year follow-up coronary angiograms regardless of the patient's anginal symptoms were studied. Morphologic changes of grafts were traced by the FitzGibbon grading system.

Results: Overall graft patency rates (FitzGibbon grade A+B) at early, 1-year, and 5-year angiography were 98.6%, 91.9%, and 88.3%, respectively. Graft patency rates in the left anterior descending artery, left circumflex artery, and right coronary artery territories were similar at early angiograms (P = .162). However, graft patency rate in the left anterior descending artery territory was higher than that in the left circumflex artery and right coronary artery territories at both the 1-year (P < .001) and 5-year (P < .001) angiograms. Of the 31 FitzGibbon grade B arterial grafts (internal thoracic artery and right gastroepiploic artery) at early angiography, 10 became occluded and 19 became grade A at 5-year angiography. In the saphenous vein grafts, grade B lesions gradually increased during the 5 postoperative years (2.6% vs 6.5% vs 13.3%).

Conclusions: Midterm angiographic follow-up demonstrated acceptable patency rates of grafts after off-pump coronary artery bypass surgery. Approximately half of the FitzGibbon grade B arterial grafts in the early angiograms became grade A at 5 years after surgery, but the proportion of grade B saphenous vein grafts gradually increased over the 5 postoperative years.