Document Detail

Coronary artery disease progression in patients who need repeat surgical revascularisation: the surgeon's point of view.
MedLine Citation:
PMID:  18268427     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study was to evaluate changes in native coronary arteries in patients undergoing repeat myocardial revascularisation late (>3 years) after primary coronary artery bypass grafting (CABG). METHODS: The angiographic images of 30 patients obtained at first and redo CABG were assessed for significant (>75%), short (<1 cm) and long (>1 cm) stenosis or total occlusion in native coronary arteries. Bypass grafts were also evaluated for significant stenosis (>50%) or occlusion. RESULTS: At first CABG, a mean number of 3.3 grafts/patient (range 1-5) were implanted. The mean time interval from first CABG to reoperation was 11.4 years (range 3-21 years). All patients showed disease progression in the native coronary arteries. At redo CABG, 3 (3.5%) grafts were non-stenotic, 27 (31%) stenotic, and 57 (65.5%) occluded. In native coronary vessels, five patients developed a new left main coronary artery stenosis, and there was a four-to-six-fold increase in total occlusions. Indications for redo CABG were disease progression in non-bypassed vessels (n = 3), bypass lesions (n = 19), and both bypass lesions and disease progression in the distal segments of native coronary arteries (n = 8). CONCLUSIONS: Late after CABG, coronary artery disease is highly progressive, mainly affecting the proximal segments of native coronary arteries, with a high incidence of coronary occlusion. Conversely, a low incidence of disease progression is observed in the distal segments of native coronary arteries, except in diabetic patients. Total arterial revascularisation as a primary strategy for CABG should be highly recommended, and more aggressive risk factor management is desirable.
Andreas Borowski; Ilja Vchivkov; Ali Ghodsizad; Emmeran Gams
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  9     ISSN:  1558-2027     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-02-12     Completed Date:  2008-03-06     Revised Date:  2009-05-28    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  85-8     Citation Subset:  IM    
Clinic for Thoracic and Cardiovascular Surgery, University of Düsseldorf, Germany.
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MeSH Terms
Aged, 80 and over
Coronary Angiography
Coronary Artery Bypass / methods*
Coronary Disease / physiopathology,  radiography*,  surgery
Disease Progression
Follow-Up Studies
Middle Aged
Retrospective Studies
Risk Factors
Time Factors

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