Ki-Bong Kim, Kwang R. Cho, Dong S. Jeong; Seoul National University Hospital, Seoul, South Korea
Objective: There have been concerns about the early and late patency of grafts after off-pump coronary artery bypass (OPCAB). We analyzed the angiographic changes of the anastomotic sites during five years after OPCAB.Methods: Of the 366 patients who underwent OPCAB between January 1998 and August 2001, 201 (54.9%) patients who received the early, one-year and five-year follow-up coronary angiographies regardless of the patient's anginal symptoms, were studied. Morphologic changes of grafts were traced using the FitzGibbon grading system.
Results: Overall graft patency rates (FitzGibbon grade A+B) after OPCAB at early, one-year, and five-year were 98.4% (610/620), 91.0% (564/620), and 86.9% (539/620), respectively. Graft patency rates in the left and right coronary territories were similar at early (98.6%, 490/497 vs 97.6%, 120/123; p=0.424) and one-year (92.0%, 457/497 vs 87.0%, 107/123; p=0.112) angiographies. However, graft patency rate at five years after surgery was higher in the left coronary territories than in the right coronary territories (88.7%, 441/497 vs 79.7%, 98/123; p=0.011). Of the 21 FitzGibbon grade B internal thoracic artery grafts in the early angiography, 48% (10/21) became occluded while 43% (9/21) became grade A in the five-year angiography. Of the 22 newly developed FitzGibbon grade B internal thoracic artery grafts at one year, 32% (7/22) became grade A while 55% (12/22) remained grade B in the five-year angiography. Of the 5 grade B right gastroepiploic artery grafts in the early angiography, 4 became grade A while one became occluded at five years after surgery. In the saphenous vein graft, grade B lesion gradually increased during the five postoperative years (2.7% vs 4.5% vs 9.1%).
Conclusion: Mid-term angiographic follow-up demonstrated acceptable patency rats of grafts after OPCAB. Approximately half of the FitzGibbon grade B arterial grafts in the early angiography became grade A at five years after surgery. On the contrary, the proportion of grade B saphenous vein grafts gradually increased during the postoperative five years.
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