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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 831-840, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BW Lytle, FD Loop, PC Taylor, C Simpfendorfer, JR Kramer, NB Ratliff, M Goormastic and DM Cosgrove
The influence of coronary artery stenoses on patient survival and event-
free survival is known, but no studies have reported the long-term outcome
of patients with stenoses in saphenous vein bypass grafts. We
retrospectively studied 723 patients who underwent a postoperative
angiographic study that documented a stenosis of 20% to 99% in at least one
saphenous vein graft and who did not undergo reoperation or percutaneous
transluminal coronary angioplasty within 1 year after that catheterization.
The mean follow-up interval was 83 months (range 1 to 237 months). For
comparison, a group of 573 patients who underwent a postoperative
catheterization that did not show any vein graft stenosis were also
followed up. Cox regression analyses were used to identify predictors of
late survival, reoperation-free survival, and event-free survival. For the
entire group of patients with stenotic vein grafts, moderate or severe
impairment of left ventricular function (p less than 0.001), interval
between operation and catheterization (p less than 0.001), older age (p =
0.001), triple-vessel or left main coronary artery disease (p = 0.004), and
stenosis of the vein graft to the left anterior descending coronary artery
(p = 0.09) were associated with decreased late survival. Patients with an
operation-to-catheterization interval greater than or equal to 5 years were
at particularly high risk, and multivariate analyses of that subgroup
confirmed that a stenotic graft to the left anterior descending artery was
a strong predictor of decreased survival (p less than 0.001), decreased
reoperation-free survival (p less than 0.001), and decreased event-free
survival (p less than 0.001). Patients greater than or equal to 5 years
postoperatively with greater than or equal to 50% stenosis of vein grafts
to the left anterior descending artery had survival of 70% and 50% at 2 and
5 years after catheterization, compared with 97% and 80% for those with
greater than or equal to 50% stenosis of the native left anterior
descending artery (p = 0.002). Late vein graft stenoses are more dangerous
than native coronary stenoses. Late stenoses in saphenous vein grafts to
the left anterior descending coronary artery predict a high rate of death
and cardiac events and are an indication for reoperation.
ARTICLES
Vein graft disease: the clinical impact of stenoses in saphenous vein bypass grafts to coronary arteries
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
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