From a Position of Known Angiographic Perfect Patency: What Happens Next?

Christopher Siderakis; Colin Royse; Justin Ren; David H Tian; Sandy Clarke-Errey; Nilesh Srivastav; Alistair Royse

doi:10.1016/j.hlc.2024.01.026

From a Position of Known Angiographic Perfect Patency: What Happens Next?

Heart Lung Circ. 2024 Mar 19:S1443-9506(24)00062-3. doi: 10.1016/j.hlc.2024.01.026. Online ahead of print.

Authors

Christopher Siderakis¹, Colin Royse², Justin Ren¹, David H Tian³, Sandy Clarke-Errey⁴, Nilesh Srivastav¹, Alistair Royse⁵

Affiliations

¹ Department of Surgery, University of Melbourne, Melbourne, Vic, Australia.
² Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia; Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.
³ Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Anaesthesia and Perioperative Management, Westmead Hospital, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
⁴ Statistical Consulting Centre, University of Melbourne, Melbourne, Vic, Australia.
⁵ Department of Surgery, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Vic, Australia. Electronic address: Alistair.Royse@gmail.com.

PMID: 38508986
DOI: 10.1016/j.hlc.2024.01.026

Abstract

Background and aim: The biological behaviour of coronary graft conduits over time may be considered by serial angiography.

Methods: A single institution retrospective cohort received mostly clinically indicated angiography between 1997 and 2020, following coronary bypass surgery. Only perfectly patent grafts (absence of any lumen irregularity) for each conduit type at the first postoperative angiogram were selected for a later comparison. The latest angiograms were at least 5 years postoperatively, and at least 1 year after first postoperative angiogram. Analysis was done according to each graft (anastomosis). Comparisons used generalised estimating equations, adjusted for binary logistic regression.

Results: Of 143 patients, there were 410 of 468 (87.6%) perfectly patent grafts at the first angiogram, analysed at 6.8±4.0 years postoperative, of which 157 were internal mammary arteries, 228 were radial arteries, and 25 were saphenous veins. At the latest angiogram (12.2±3.8 years postoperative), comparison with the first angiogram for each individual graft found preserved perfect patency for internal mammary arteries 156 of 157 (99.4%), and for radial arteries, 227 of 228 (99.6%) but saphenous veins deteriorated considerably 13 of 25 (52.0%). The two arterial grafts (internal mammary and radial) were superior to vein grafts (odds ratio 163; 95% confidence interval [CI] 22-1,211; p<0.001), but not different from each other (odds ratio 0.95; 95% CI 0.78-1.16; p=0.584).

Conclusions: From a position of known angiographic perfect patency post-CABG, internal mammary artery and radial artery grafts retained their perfect patency in the longer term, but saphenous vein grafts did not.

Keywords: Internal mammary artery; Perfect patency; Radial artery; Saphenous vein; Serial angiography.