Coronary artery disease progression in patients who need repeat surgical revascularisation: the surgeon's point of view.
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.
Borowski
Andreas
A
Clinic for Thoracic and Cardiovascular Surgery, University of Düsseldorf, Germany. borowski@med.-uni.duesseldorf.de
Vchivkov
Ilja
I
Ghodsizad
Ali
A
Gams
Emmeran
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors