Document Detail


Angiographic predictors of 6-month patency of bypass grafts implanted to the right coronary artery a prospective randomized comparison of gastroepiploic artery and saphenous vein grafts.
MedLine Citation:
PMID:  18191734     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to define the pre-operative angiographic variables that could influence graft patency and flow pattern. BACKGROUND: Saphenous vein grafts (SVG) and pedicled right gastroepiploic artery (RGEA) grafts are routinely used to revascularize the right coronary artery (RCA). Little is known about the predictive value of objective pre-operative angiographic parameters on the 6-month graft patency and on the interest of these parameters to select the optimal graft material in individual cases. METHODS: We prospectively enrolled 172 consecutive patient candidates for coronary revascularization. Revascularization of the RCA was randomly performed with SVG in 82 patients or with the RGEA in 90 patients. Both groups were comparable with respect to all pre-operative continuous and discrete variable and risk factors. All patients underwent a systematic angiographic control 6 months after surgery. Pre-operative angiographic parameters included minimal lumen diameter (MLD), percent stenosis and reference diameter of the RCA measured by quantitative angiography (CAAS II system, Pie Medical, Maastricht, the Netherlands), location of the stenosis, run off of the RCA, and regional wall motion of the revascularized territory. RESULTS: A significant difference in the distribution of flow patterns was observed between SVG and RGEA. In multivariate analysis, graft-dependent flow pattern was significantly associated with both MLD and percent stenosis of the RCA in the RGEA group but with percent stenosis only in the SVG group. In the RGEA group, the proportion of patent grafts was higher when MLD was below a threshold value lying in the third MLD quartile (0.77 to 1.40 mm). CONCLUSIONS: Pre-operative angiography predicts graft patency in RGEA, whereas the flow pattern in SVG is significantly less influenced by quantitative angiographic parameters.
Authors:
David Glineur; William D'hoore; Gebrine El Khoury; Sixte Sondji; Gregory Kalscheuer; Jean-Christophe Funken; Jean Rubay; Alain Poncelet; Parla Astarci; Robert Verhelst; Philippe Noirhomme; Claude Hanet
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-14     Completed Date:  2008-02-05     Revised Date:  2008-09-19    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  120-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Medicine and Surgery, University of Louvain Medical School, Brussels, Belgium. david.glineur@clin.ucl.ac.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography / methods
Coronary Artery Bypass / adverse effects,  methods*
Coronary Restenosis / prevention & control,  radiography
Coronary Stenosis / mortality,  radiography*,  surgery*
Female
Follow-Up Studies
Gastroepiploic Artery / transplantation*
Graft Rejection
Graft Survival
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Postoperative Complications
Preoperative Care / methods
Probability
Prospective Studies
Reference Values
Risk Assessment
Saphenous Vein / transplantation*
Survival Rate
Time Factors
Treatment Outcome
Vascular Patency / physiology*
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2008 Jan 15;51(2):126-8   [PMID:  18191735 ]
J Am Coll Cardiol. 2008 Sep 2;52(10):886-7; author reply 887-8   [PMID:  18755356 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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