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.