Circulation, Vol 57, 1070-1074, Copyright © 1978 by American Heart Association
GM FitzGibbon, JR Burton and AJ Leach
All 1400 coronary bypass grafts, in 409 survivors of 414 patients
undergoing 440 consecutive bypass operations, were selectively opacified in
multiplane cineangiograms prior to hospital discharge and 1132 (81%) were
restudied at one year. Grafts were graded A (excellent), B (fair) or O
(occluded) by separate assessment of proximal and distal anastomoses and
bypass trunks. In early graft studies 89% were patent (A and B), 79% graded
A; at one year, 81% were patent, 74% graded A. Circumflex-marginal grafts
fared less well early, but similarly late, compared with other grafts. Of
all grafts graded B early, 37% became A, 39% remained B and 24% were
occluded at one year; 90% of early graded A grafts remained so, 4% became B
and 6% occluded; the grading system seems to have had useful predictive
value. Distal anastomosis defects dictated early B grading in 81.3% of
cases, trunk defects in 12.5% and proximal anastomosis defects in 2.7%.
Trunk defects carried a worse prognosis for occlusion than did distal
anastomosis defects. Side-to-side, vein-coronary anastomoses had a
significantly higher patency rate than terminal end-to-side coronary
anastomoses with the same veins.
ARTICLES
Coronary bypass graft fate: angiographic grading of 1400 consecutive grafts early after operation and of 1132 after one year
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