The Thoracic and cardiovascular surgeon
-
Thorac Cardiovasc Surg · Jun 1996
The impact of arterial hypertension on the results of coronary artery bypass grafting.
Arterial hypertension is though to be associated with reduced coronary vasodilator reserve in the coronary microcirculation. Increased ventricular mass and coronary arteriolar abnormalities are the dominant features in patients with severe hypertension, while large-vessel coronary disease is the predominant feature in patients with mild hypertension. In the present study we have evaluated how hypertension influences the outcome of coronary artery bypass grafting (CABG), with emphasis on patients with preoperative left-ventricular ejection fraction (LVEF) < or = 25%. ⋯ Hypertensive patients also had a better improvement of their left-ventricular function and CCS class than normotensiven. Left-ventricular hypertrophy and previous myocardial infarction were predictors for mortality in patients with LVEF > 25%. Patients with LVEF < or = 25% showed the same tendency, though not statistically significant.
-
Thorac Cardiovasc Surg · Jun 1996
Extrathoracic arteriosclerotic vascular changes preclude the use of the internal thoracic artery for coronary artery bypass grafting.
During a two-years period we have treated 6 patients where use of the internal thoracic artery for coronary artery grafting was precluded because of extrathoracic arteriosclerotic vascular lesions. In four patients with severe aorto-iliac occlusive disease preoperative digital angiography demonstrated collateralisation of the lower extremity by either the left, right, or both internal thoracic arteries (ITA). In these cases use of the ITA was excluded in order to preserve the collateral supply and coronary bypass grafting was performed using only saphenous vein. ⋯ All patients survived the operation without development of a perioperative myocardial infarction, neurological deficit, or peripheral ischemia. Although they rarely do, extrathoracic vascular disorders can exclude the use of the ITA for grafting. Especially in the case of aorto-iliac occlusive disease or proximal arteriosclerotic subclavian lesions angiographic evaluation is mandatory to prevent the development of life-threatening peripheral ischemia by harvesting an ITA and to avoid the use of an inadequate ITA graft with in-flow occlusion.