Angiographic Results After Coronary Artery Bypass Grafting

The main place among cardiovascular diseases takes coronary heart disease. The number of coronary artery bypass surgery increases every year. The large number of coronary artery bypass grafting (CABG) performed worldwide. The need for assessment of grafts patency is enormous. Objective. We are performed analyze of graft patency results, after CABG surgery in our clinic. Materials and Methods. The paper presents the results of a retrospective analysis of angiographic graft patency data depends of TIMI flow, Syntax score, diameter and degree of vascular lesions, as well as the surgery type. Results. According angiographic data of 142 patients, we found that 74 (52.1%) had no graft dysfunction. In the 68 (47.9%) patients had various types graft dysfunction which is 3.0% of the total number of operated patients in our center for coronary heart disease. 31 (46%) patients were operated under Off pump, 19 (28%) - On pump and 18 (26%) - in a parallel bypass technic. According to our data parameters such as Syntax score, the diameter of the vessel and the percentage of lesion, its did not significantly affect the grafts patency in terms of up to 12,7±6,5 months. Preoperative coronary blood flow (assessed by TIMI scale) the significantly affects the grafts patency. Conclusions. In the graft patency for perioperative period and follow-up, significantly affected preoperative coronary blood flow assessed by TIMI. The results of beating heart (off pump and using a parallel IR) and On pump surgery similar in the immediate postoperative period. But there is tend to increase graft dysfunction in up to 30 months in patients after off pump surgery. We don’t found relation between Syntax score, the diameter of the coronary arteries, the percentage of stenosis and graft patency after 12 months follow-up.

аортокоронарное шунтирование, оff pump, оn pump, шунтография, coronary artery bypass grafting, оff pump, оn pump

1. Здравоохранение в России. 2015: Стат. сб./Росстат. М.: 2011; 326 с.

2. WHO Global Info Base, 2011. URL: http: www.infobase.int.

3. Sessuys P. W., Feyter P., Macaya C. et al. (LIPS) Fluvastatin for prevention of Cardial events following Successful first percutaneos coronary intervention. A Randomized Controlled Trial. JAMA 2002; 287 (24): 3215-3220. DOI.org/10.1001/jama.287.24.3215.

4. Кремнев Ю. А. Реабилитация больных после аортокоронарного шунтирования.) 2008; http://www.smclinic.ru

5. Рекомендации по реваскуляризации миокарда. Рациональная фармакотерапия в кардиологии. 2011; № 3: 24с.

6. Stamou S. C. and Paul J. Corso. Coronary revascularization without cardiopulmonary bypass in high-risk patients: a route to the future. Ann Thorac Surg 2001; 71: 1056-1061. D0I.org/10.1016/s0003-4975 (00) 02325-0.

7. Национальные рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная терапия и профилактика 2008; 7 (6): 1-46.

8. Беленков Ю. Н., Акчурин Р. С., Савченко А. П. и др. Результаты коронарного стентирования и хирургического лечения больных ишемической болезнью сердца с многососудистым поражением коронарного русла. Кардиология 2002; 5: 42-47.

9. Вачерский Ю. Б., Андреев С. Л., Затолокин В. В. Сравнительное исследования функционирования различных аутоартериальных и венозных графиков по данным шунтографии после изолированного коронарного шунтирования. Сибирский медицинский журнал 2010; 4 (25): 43-49.

10. Овесян З. Р., Верне Ж. Ш., Рафаели Т. Р. Влияние оптимальной пульсурежающей терапии на течение восстановительного периода у больных ишемической болезнью сердца, подвергшихся хирургической реваскуляризации миокарда. Международный журнал интервенционной кардиоангиологии 2005; 9: 34-39.

11. Шелковникова Т. А., Мордвин В. Ф., Козлов Б. Н. и др. Отдаленные результаты аортокоронарного шунтирования у больных с артериальной гипертонией. Сибирский медицинский журнал 2007; 1 (22): 26-29.

12. Аптекарь В. Д., Тепляков А. Т., Желтоногова Н. М. Влияние липидных факторов риска ишемической болезни сердца на прогрессирование коронарной недостаточности у больных, подвергшихся операции коронарного шунтирования, в ранние и отдаленные (до 10 лет) сроки после вмешательства. Клиническая физиология кровообращения 2007; 4: 55-63.

13. Ежов М. В., Сафарова М. С., Афанасьева О. И. и др. Высокий уровень липопротеида (А) как предиктор неблагоприятного прогноза в отдаленные сроки после операции коронарного шунтирования. Кардиология 2011; 51 (1): 18-22.

14. Blacher J., Benetos A., Kirzin J. et al. Relation of plasma homocysteine to cardiovascular mortality in a French population. Am J. Cardiol 2002; 90 (6): 591-595. DOI.org/10.1016/s0002-9149 (02) 02561-4.

15. Lindal E. Post-operative depression and coronary bypass surgery. Int-Disabil-Stud 1990; 12 (2): 70-74. DOI.org/10.3109/0379079 9009166254.

16. Segura J., Christiansen H., Campo C., Ruilope L. M. How to titrate ACE inhibitors and angiotensin receptor blockers in renal patients; according to blood pressure or proteinuria? Curr Hyper Rep 2003; 5: 426-429. DOI.org/10.1007/s11906-003-0089-7.

17. Акчурин P. C., Ширяев А. А. Актуальные проблемы коронарной хирургии. М.: ГЭОТАР-МЕД, 2004. 88 с.

18. Rankin J. S., Tuttle R. H., Wechsler A. S. et al. Techniques and benefit of multiple internal mammary artery bypass at 20 year of follow up. Ann Thorac Surg 2007; 83: 1008-1015. DOI.org/10.1016/j.athoracsur. 2006.10.032.

19. Tatoulis J., Wynne R., Skillington P. D., Buxton B. F. Total Arterial Revascularization: A Superior Strategy for Diabetic Patients Who Require Coronary Surgery. Ann Thorac Surg 2016; pii: S0003-4975 (16) 30557-4. DOI: 10.1016/j.athoracsur. 2016.05.062.

20. Perrotti A., Spina A., Dorigo E. et al. Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience. Thorac Cardiovasc Surg 2016. DOI: 10.1055/s-0036-1584688.

21. Locker C., Schaff H. V., Daly R. C. Multiple arterial grafts improve survival with coronary artery bypass graft surgery versus conventional coronary artery bypass grafting compared with percutaneous coronary interventions. J. Thorac Cardiovasc Surg 2016; 152 (2): 369-379. e4. DOI: 10.1016/j.jtcvs.2016.03.089.

22. Shneider Y. A., Antipov G. N., Belov V. A. et al. Mediastinitis after cardiac surgery: clinical features, classification and treatment. New Armenian Medical Journal 2015; 9 (1): 45-53.

23. Puskas J. D., Kilgo P. D., Lattouf O. M. et al. Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg 2008; 86: 1139-1146. DOI. org/10.1016/j.athoracsur.2008.05.073.

24. Serrao M., Graca F., Rodrigues R. et al. Coronary artery bypass grafting in octogenarians: long-term results. Rev Port Cardiol 2010; 29: 989-998.

25. Yasunori C., Shinichiro S., Akira A. et al. The SYNTAX score is correlated with long-term outcomes of coronary artery bypass grafting for complex coronary artery lesions. Interact Cardiovasc Thoras Surg 2016; 23 (1): 125-132. DOI: 10.1093/icvts/ivw057.

26. Danny Chu, Bakaeen F. G., Dao T. K. et al. данные об авторе добавлены On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in a Cohort of 63,000 Patients. Ann Thoras Surg 2009; 87: 1820-1827. DOI.org/10.1016/j.athoracsur.2009.03.052.

27. Singh A., Schaff H. V., Mori Brooks M. On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. Eur J. Cardiothorac Surg 2016; 49 (2): 406-416. DOI: 10.1093/ejcts/ezv170.

28. Lemesle G., Bonello L., de Labriolle A. et al. Prognostic value of the Syntax score in patients undergoing coronary artery bypass grafting for three-vessel coronary artery disease. Catheter Cardiovasc Interv 2009; 73 (5): 612-617. DOI: 10.1002/ccd.21883.

29. Shiono Y., Kubo T., Honda K. et al. Impact of functional focal versus diffuse coronary artery disease on bypass graft patency. Int J. Cardiol 2016; 222: 16-21. DOI: 10.1016/j. ijcard. 2016.07.052.

30. Gaudino M., Niccoli G., Roberto M. et al. The Same Angiographic Factors Predict Venous and Arterial Graft Patency: A Retrospective Study. Medicine (Baltimore). 2016; 95 (1): e2068. DOI: 10.1097/MD.0000000000002068.