Fate of bypass grafts onto totally occluded coronary arteries.
BACKGROUND
Chronically occluded coronary arteries often develop good collateralisation, that leads to retrograde perfusion of these vessels, as regularly seen in coronary angiograms. Retrograde perfusion constitutes a form of competitive flow, which in turn is associated with an increased risk for early bypass graft failure. The aim of our study is to investigate the patency rate of bypass grafts onto totally occluded coronary arteries, in the presence of retrograde flow.


METHODS
Two groups of patients were followed up by cardiac catheterisation. One month after undergoing coronary artery bypass grafting. Group 1 (n=33) had coronary three vessel disease, with one totally occluded coronary artery and evidence of retrograde flow in the preoperative coronary angiogram. Group 2 (n=30) was the control group, with coronary three vessel disease and without totally occluded coronaries. We used internal mammary arteries and saphenous vein grafts as conduits.


RESULTS
Thirty-six point thirty-six per cent of bypass grafts onto totally occluded coronaries were occluded one month postoperatively (n=12). Graft failure in the control group was 13.3%. Significance p=0.03.


CONCLUSIONS
In view of our findings we conclude, that there is a significantly increased incidence of early graft failure, when totally occluded coronary arteries are revascularised, that show retrograde flow in the preoperative coronary angiogram.
Doss
M
M
Department of Thoracic and Cardiovascular Surgery, University Frankfurt am Main, Germany. mirkodoss@aol.com
Hemmer
W
W
D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000473:pathology*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000502:physiology*; D008875:Middle Aged; D011183:Postoperative Complications; D012501:Saphenous Vein / Q000502:physiology*; D012720:Severity of Illness Index