Coronary artery bypass graft surgery: Causes and rates of graft failure
- Sary Aranki, MD
Sary Aranki, MD
- Associate Professor of Surgery
- Harvard Medical School
- Julian M Aroesty, MD
Julian M Aroesty, MD
- Clinical Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Edward Verrier, MD
Edward Verrier, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington School of Medicine
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Medical School
Coronary artery bypass graft surgery (CABG) is recommended for patients with obstructive coronary artery disease whose survival will be improved compared to medical therapy or percutaneous coronary intervention (PCI). In addition, patients with angina refractory to medical therapy may receive a recommendation for CABG if PCI cannot be performed. The procedure involves the construction of one or more grafts between the arterial and coronary circulations. Most patients receive both arterial and venous grafts during CABG and long-term graft patency is significantly better with the former. Potential consequences of graft failure (loss of patency) include the development of angina, myocardial infarction, or cardiac death.
This topic will briefly discuss the causes of graft failure and rates of patency for the various coronary bypass grafts. The following issues are discussed elsewhere:
●Operative mortality. (See "Operative mortality after coronary artery bypass graft surgery".)
●Early noncardiac complications. (See "Early noncardiac complications of coronary artery bypass graft surgery".)
●Early cardiac complications. (See "Early cardiac complications of coronary artery bypass graft surgery".)
- Fitzgibbon GM, Kafka HP, Leach AJ, et al. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol 1996; 28:616.
- Björk VO, Ekeström S, Henze A, et al. Early and late patency of aortocoronary vein grafts. Scand J Thorac Cardiovasc Surg 1981; 15:11.
- Cataldo G, Braga M, Pirotta N, et al. Factors influencing 1-year patency of coronary artery saphenous vein grafts. Studio Indobufene nel Bypass Aortocoronarico (SINBA). Circulation 1993; 88:II93.
- Roth JA, Cukingnan RA, Brown BG, et al. Factors influencing patency of saphenous vein grafts. Ann Thorac Surg 1979; 28:176.
- Harskamp RE, Lopes RD, Baisden CE, et al. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013; 257:824.
- Hess CN, Lopes RD, Gibson CM, et al. Saphenous vein graft failure after coronary artery bypass surgery: insights from PREVENT IV. Circulation 2014; 130:1445.
- Shi Y, O'Brien JE Jr, Mannion JD, et al. Remodeling of autologous saphenous vein grafts. The role of perivascular myofibroblasts. Circulation 1997; 95:2684.
- Yang Z, Oemar BS, Carrel T, et al. Different proliferative properties of smooth muscle cells of human arterial and venous bypass vessels: role of PDGF receptors, mitogen-activated protein kinase, and cyclin-dependent kinase inhibitors. Circulation 1998; 97:181.
- Chello M, Mastroroberto P, Perticone F, et al. Nitric oxide modulation of neutrophil-endothelium interaction: difference between arterial and venous coronary bypass grafts. J Am Coll Cardiol 1998; 31:823.
- Lüscher TF, Diederich D, Siebenmann R, et al. Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 1988; 319:462.
- Kauhanen P, Sirén V, Carpén O, et al. Plasminogen activator inhibitor-1 in neointima of vein grafts: its role in reduced fibrinolytic potential and graft failure. Circulation 1997; 96:1783.
- Kockx MM, De Meyer GR, Bortier H, et al. Luminal foam cell accumulation is associated with smooth muscle cell death in the intimal thickening of human saphenous vein grafts. Circulation 1996; 94:1255.
- Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation 1998; 97:916.
- Yang Z, Ruschitzka F, Rabelink TJ, et al. Different effects of thrombin receptor activation on endothelium and smooth muscle cells of human coronary bypass vessels. Implications for venous bypass graft failure. Circulation 1997; 95:1870.
- Goldman S, Zadina K, Moritz T, et al. Long-term patency of saphenous vein and left internal mammary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Affairs Cooperative Study. J Am Coll Cardiol 2004; 44:2149.
- Goldman S, Zadina K, Krasnicka B, et al. Predictors of graft patency 3 years after coronary artery bypass graft surgery. Department of Veterans Affairs Cooperative Study Group No. 297. J Am Coll Cardiol 1997; 29:1563.
- Domanski MJ, Borkowf CB, Campeau L, et al. Prognostic factors for atherosclerosis progression in saphenous vein grafts: the postcoronary artery bypass graft (Post-CABG) trial. Post-CABG Trial Investigators. J Am Coll Cardiol 2000; 36:1877.
- Schwartz L, Kip KE, Frye RL, et al. Coronary bypass graft patency in patients with diabetes in the Bypass Angioplasty Revascularization Investigation (BARI). Circulation 2002; 106:2652.
- Sabik JF 3rd. Understanding saphenous vein graft patency. Circulation 2011; 124:273.
- Mehta RH, Ferguson TB, Lopes RD, et al. Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial. Circulation 2011; 124:280.
- Ferguson TB Jr, Coombs LP, Peterson ED. Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement? J Thorac Cardiovasc Surg 2002; 123:869.
- Leavitt BJ, O'Connor GT, Olmstead EM, et al. Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery. Circulation 2001; 103:507.
- Berger PB, Alderman EL, Nadel A, Schaff HV. Frequency of early occlusion and stenosis in a left internal mammary artery to left anterior descending artery bypass graft after surgery through a median sternotomy on conventional bypass: benchmark for minimally invasive direct coronary artery bypass. Circulation 1999; 100:2353.
- Ura M, Sakata R, Nakayama Y, et al. Analysis by early angiography of right internal thoracic artery grafting via the transverse sinus : predictors of graft failure. Circulation 2000; 101:640.
- Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1986; 314:1.
- Tatoulis J, Buxton BF, Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 2004; 77:93.
- Sabik JF 3rd, Lytle BW, Blackstone EH, et al. Comparison of saphenous vein and internal thoracic artery graft patency by coronary system. Ann Thorac Surg 2005; 79:544.
- Tatoulis J, Buxton BF, Fuller JA, Royse AG. Total arterial coronary revascularization: techniques and results in 3,220 patients. Ann Thorac Surg 1999; 68:2093.
- Dabal RJ, Goss JR, Maynard C, Aldea GS. The effect of left internal mammary artery utilization on short-term outcomes after coronary revascularization. Ann Thorac Surg 2003; 76:464.
- Endo M, Nishida H, Tomizawa Y, Kasanuki H. Benefit of bilateral over single internal mammary artery grafts for multiple coronary artery bypass grafting. Circulation 2001; 104:2164.
- Albertini A, Lochegnies A, El Khoury G, et al. Use of the right gastroepiploic artery as a coronary artery bypass graft in 307 patients. Cardiovasc Surg 1998; 6:419.
- Ochi M, Bessho R, Saji Y, et al. Sequential grafting of the right gastroepiploic artery in coronary artery bypass surgery. Ann Thorac Surg 2001; 71:1205.
- Acar C, Ramsheyi A, Pagny JY, et al. The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years. J Thorac Cardiovasc Surg 1998; 116:981.
- Zacharias A, Habib RH, Schwann TA, et al. Improved survival with radial artery versus vein conduits in coronary bypass surgery with left internal thoracic artery to left anterior descending artery grafting. Circulation 2004; 109:1489.
- Weinschelbaum EE, Macchia A, Caramutti VM, et al. Myocardial revascularization with radial and mammary arteries: initial and mid-term results. Ann Thorac Surg 2000; 70:1378.
- Iacò AL, Teodori G, Di Giammarco G, et al. Radial artery for myocardial revascularization: long-term clinical and angiographic results. Ann Thorac Surg 2001; 72:464.
- Khot UN, Friedman DT, Pettersson G, et al. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation 2004; 109:2086.
- Maniar HS, Sundt TM, Barner HB, et al. Effect of target stenosis and location on radial artery graft patency. J Thorac Cardiovasc Surg 2002; 123:45.
- Desai ND, Cohen EA, Naylor CD, et al. A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. N Engl J Med 2004; 351:2302.
- Collins P, Webb CM, Chong CF, et al. Radial artery versus saphenous vein patency randomized trial: five-year angiographic follow-up. Circulation 2008; 117:2859.
- Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: a randomized trial. JAMA 2011; 305:167.
- Muneretto C, Negri A, Manfredi J, et al. Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation. J Thorac Cardiovasc Surg 2003; 125:826.
- Sundt TM 3rd, Barner HB, Camillo CJ, Gay WA Jr. Total arterial revascularization with an internal thoracic artery and radial artery T graft. Ann Thorac Surg 1999; 68:399.
- Muneretto C, Bisleri G, Negri A, et al. Total arterial myocardial revascularization with composite grafts improves results of coronary surgery in elderly: a prospective randomized comparison with conventional coronary artery bypass surgery. Circulation 2003; 108 Suppl 1:II29.
- Baskett RJ, Cafferty FH, Powell SJ, et al. Total arterial revascularization is safe: multicenter ten-year analysis of 71,470 coronary procedures. Ann Thorac Surg 2006; 81:1243.