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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 773-778, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GM FitzGibbon, AJ Leach, WJ Keon, JR Burton and HP Kafka
A total of 1,179 vein grafts were studied angiographically in 353 (45%)
unselected survivors (male, mean age 45.5 years) of 786 coronary bypass
operations. Studies were conducted early (0.96 months), 1 year (12.8
months), and 5 years (59.7 months) postoperatively. A previously described
technique was used to grade the patency of the grafts, and a new technique
was used to assess intimal irregularity, presumably caused by
atherosclerosis; this new technique indicated both intimal surface
distribution of disease and profile (relief or elevation). Ten percent,
17%, and 26% of grafts were occluded early, at 1 year, and at 5 years,
respectively. Distal anastomotic defects were the commonest cause for low
grades in the patency classification. Irregularities in patent grafts
increased from 9% at 1 year to 42% at 5 years, with 11% of all the 1 year
lesions and 20% of all the 5 year lesions having a high profile (more than
50% graft stenosis); of the lesions categorized as showing the widest
surface spread, 17% were in high relief at 1 year and 34% at 5 years. Thus,
the lesions we believed to be atherosclerotic proliferated in both surface
spread and elevation. All severely diseased grafts at the 1 year study had
been normal in outline early; 79% at the 5 year study had been disease free
at 1 year. All newly occluded grafts at the 1 year study had been normal in
outline and 82% had had good patency early; 78% of newly occluded grafts at
the 5 year study had been disease free at 1 year and 77% had had good
patency. Normal appearance of the intima in grafts studied at 1 year had no
prognostic value for 5 year findings. However, 62% of all grafts with the
appearance of intimal disease at 1 year showed deterioration by 5 years,
and 28% were occluded. The differences between these outcomes are highly
significant (p less than 0.0005). In conclusion, the appearance of intimal
irregularity compatible with atherosclerosis in a coronary bypass graft 1
year after operation carried a poor prognosis for adverse angiographic
change at 5 years. On the other hand, normally appearing intima at 1 year
had no predictive valve for the 5 year study despite a generally better
prognosis for nondiseased grafts.
ARTICLES
Coronary bypass graft fate. Angiographic study of 1,179 vein grafts early, one year, and five years after operation
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