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The Journal of Thoracic and Cardiovascular Surgery, Vol 87, 17-26, Copyright © 1984 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting

G Dorros, WD Johnson, AJ Tector, TM Schmahl, SL Kalush and L Janke

Percutaneous transluminal coronary angioplasty (PTCA) has been used to treat patients with prior coronary artery bypass grafting who have stenosis of a saphenous vein graft and/or a native artery. During 53 months, 61 patients underwent 105 angioplasty attempts. Eighty lesions (76%) were successfully dilated in 46 of 61 patients (75%). Success in a patient was determined by a greater than or equal to 20% decrease in the percent diameter stenoses coupled with an improved clinical response; 52 patients had one prior CABG and nine patients had two or more prior CABGs. Multivessel disease was present in 56 patients (92%). A vein graft stenosis was successfully dilated in 26 of 33 cases (79%)-- 19 of 25 (76%) at an anastomotic site and seven of eight (88%) in the graft body. An arterial stenosis was successfully dilated in 37 of 52 cases (71%)--18 of 22 (82%) in the left anterior descending, 13 of 22 (59%) in the circumflex, 21 of 26 (81%) in the right coronary, and two (100%) in the left main coronary artery. There is no statistically significant difference in the incidence of success in dilating a vein graft or native artery. Complications included: one emergency CABG (1.6%), three myocardial infarctions (4.9%), and two deaths (3.3%). There were 15 unsuccessful PTCAs: Ten patients had elective CABG, one had emergency CABG, two received medical treatment, and two died. Forty- six patients are being followed-up: Twenty-eight (61%) continue to do clinically well, seven (15%) had another PTCA and remain well, and 10 (16%) had elective CABG because of restenosis and/or disease progression. There was one late death and one late myocardial infarction. Thus, 35 patients (57%) had continued clinical success without the need for repeat CABG; 89% had no angina or improved angina, and 90% had improved exercise treadmill results. PTCA is technically feasible in selected patients with prior CABG and can achieve a clinical response with an acceptable complication rate when compared to repeat CABG.

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