Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1985 Dec;40(12):940–947. doi: 10.1136/thx.40.12.940

State of the vein grafts, native coronary arteries, and myocardium and principal cause of death in patients dying after aortocoronary bypass grafting.

A G Rose
PMCID: PMC460231  PMID: 3879391

Abstract

Fifty five patients with 108 coronary bypass saphenous vein grafts were studied at necropsy. The mean duration of the grafts was 153 days (SD 516). The luminal narrowing of the native coronary arteries proximal to, at, and distal to the vein graft anastomoses and the narrowing of the non-grafted arteries were evaluated planimetrically. Twenty nine per cent of coronary arteries distal to graft anastomoses showed at least 76% narrowing and 50-75% occlusion was seen in 39% of such arteries. Fifty three per cent of non-grafted arteries showed at least 76% luminal narrowing and 26% had 50-75% narrowing. Six patients (11%) had surgically induced dissection of coronary arteries. Seventy seven vein grafts (71%) showed no appreciable luminal narrowing. Problems related to operative technique caused 30% of the deaths.

Full text

PDF
940

Images in this article

942Image
on p.942
942Image
on p.942
942Image
on p.942
943Image
on p.943
944Image
on p.944
944Image
on p.944

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnard P. M., Lubbe J. J., Rossouw J. J., Weich H. F. Aortokoronêre omleidingschirurgie te Tygerberg-hospitaal, 1978-1980. S Afr Med J. 1982 Nov 13;62(21):756–758. [PubMed] [Google Scholar]
  2. Bical O., Bachet J., Laurian C., Camilleri J. P., Goudot B., Menu P., Guilmet D. Aortocoronary bypass with homologous saphenous vein: long-term results. Ann Thorac Surg. 1980 Dec;30(6):550–557. doi: 10.1016/s0003-4975(10)61729-8. [DOI] [PubMed] [Google Scholar]
  3. Bonchek L. I., Boerboom L. E., Olinger G. N., Pepper J. R., Munns J., Hutchinson L., Kissebah A. H. Prevention of lipid accumulation in experimental vein bypass grafts by antiplatelet therapy. Circulation. 1982 Aug;66(2):338–341. doi: 10.1161/01.cir.66.2.338. [DOI] [PubMed] [Google Scholar]
  4. Bramlet D. A., Behar V. S., Ideker R. E. Aneurysm of a saphenous vein bypass graft associated with aneurysms of native coronary arteries. Cathet Cardiovasc Diagn. 1982;8(5):489–494. doi: 10.1002/ccd.1810080510. [DOI] [PubMed] [Google Scholar]
  5. Brody W. R., Kosek J. C., Angell W. W. Changes in vein grafts following aorto-coronary bypass induced by pressure and ischemia. J Thorac Cardiovasc Surg. 1972 Dec;64(6):847–854. [PubMed] [Google Scholar]
  6. Bulkely B. H., Hutchins G. M. Myocardial consequences of coronary artery bypass graft surgery. The paradox of necrosis in areas of revascularization. Circulation. 1977 Dec;56(6):906–913. doi: 10.1161/01.cir.56.6.906. [DOI] [PubMed] [Google Scholar]
  7. Bulkley B. H., Hutchins G. M. Acute postoperative graft phlebitis: a rare cause of saphenous vein-coronary artery bypass failure. Am Heart J. 1978 Jun;95(6):757–760. doi: 10.1016/0002-8703(78)90507-0. [DOI] [PubMed] [Google Scholar]
  8. Bulkley B. H., Roberts W. C. Heterografts as aortocoronary bypass conduits in human beings. Am J Cardiol. 1975 Nov;36(6):823–828. doi: 10.1016/0002-9149(75)90467-1. [DOI] [PubMed] [Google Scholar]
  9. Cheanvechai C., Effler D. B., Hooper J. R., Eschenbruch E. M., Sheldon W. C., Sones F. M., Jr, Levin H. S., Hawk W. A. The structural study of the saphenous vein. Ann Thorac Surg. 1975 Dec;20(6):636–645. doi: 10.1016/s0003-4975(10)65755-4. [DOI] [PubMed] [Google Scholar]
  10. Chesebro J. H., Clements I. P., Fuster V., Elveback L. R., Smith H. C., Bardsley W. T., Frye R. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982 Jul 8;307(2):73–78. doi: 10.1056/NEJM198207083070201. [DOI] [PubMed] [Google Scholar]
  11. Chesebro J. H., Fuster V., Elveback L. R., Clements I. P., Smith H. C., Holmes D. R., Jr, Bardsley W. T., Pluth J. R., Wallace R. B., Puga F. J. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984 Jan 26;310(4):209–214. doi: 10.1056/NEJM198401263100401. [DOI] [PubMed] [Google Scholar]
  12. Duvenhage H., Sinclair G. S., Küstner H. G. Deaths from ischaemic heart disease in White South Africans, 1963-1977. S Afr Med J. 1982 Aug 14;62(8):231–234. [PubMed] [Google Scholar]
  13. Grondin C. M., Dyrda I., Pasternac A., Campeau L., Bourassa M. G., Lespérance J. Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation. 1974 Apr;49(4):703–708. doi: 10.1161/01.cir.49.4.703. [DOI] [PubMed] [Google Scholar]
  14. Guiteras Val P., Pelletier L. C., Hernandez M. G., Jais J. M., Chaitman B. R., Dupras G., Solymoss B. C. Diagnostic criteria and prognosis of perioperative myocardial infarction following coronary bypass. J Thorac Cardiovasc Surg. 1983 Dec;86(6):878–886. [PubMed] [Google Scholar]
  15. Hall D., Corzo O., Douglas J., Gruentzig A. R. Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery. Int J Cardiol. 1984 Nov;6(5):645–650. doi: 10.1016/0167-5273(84)90012-3. [DOI] [PubMed] [Google Scholar]
  16. Hamaker W. R., Doyle W. F., O'Connell T. J., Jr, Gomez A. C. Subintimal obliterative proliferation in saphenous vein grafts. A cause of early failure of aorta-to-coronary artery bypass graft. Ann Thorac Surg. 1972 May;13(5):488–493. doi: 10.1016/s0003-4975(10)65162-4. [DOI] [PubMed] [Google Scholar]
  17. Harris L. S. Endocardial lesions following coronary artery by-pass surgery. Forensic Sci. 1976 Jul-Aug;8(1):53–62. doi: 10.1016/0300-9432(76)90047-9. [DOI] [PubMed] [Google Scholar]
  18. Hilal A., Easley R. M., Jr, Pande P., Sengupta A. Pericardial constriction following myocardial revascularization. N Y State J Med. 1982 Jun;82(7):1083–1086. [PubMed] [Google Scholar]
  19. Islam M. N., Zikria E. A., Sullivan M. E., Koimattur A., Ford W. B., Samadani S. R., Miller W. H. Aortocoronary Gore-Tex graft: 18-month patency. Ann Thorac Surg. 1981 Jun;31(6):569–573. doi: 10.1016/s0003-4975(10)61351-3. [DOI] [PubMed] [Google Scholar]
  20. Kennedy J. H., Wieting D. W., Hwang N. H., Anderson M. S., Bayardo R. J., Howell J. F., De Bakey M. E. Hydraulic and morphologic study of fibrous intimal hyperplasia in autogenous saphenous vein bypass grafts. J Thorac Cardiovasc Surg. 1974 May;67(5):805–813. [PubMed] [Google Scholar]
  21. Keon W. J., Heggtveit H. A., Leduc J. Perioperative myocardial infarction caused by atheroembolism. J Thorac Cardiovasc Surg. 1982 Dec;84(6):849–855. [PubMed] [Google Scholar]
  22. Kern W. H., Dermer G. B., Lindesmith G. G. The intimal proliferation in aortic-coronary saphenous vein grafts. Light and electron microscopic studies. Am Heart J. 1972 Dec;84(6):771–777. doi: 10.1016/0002-8703(72)90070-1. [DOI] [PubMed] [Google Scholar]
  23. Kern W. H. Morphology of saphenous vein-coronary artery bypass grafts. Arch Pathol Lab Med. 1983 Jul;107(7):389–389. [PubMed] [Google Scholar]
  24. Lam R., Robinson M. J., Morales A. R. Aortic dissection complicating aortocoronary saphenous vein bypass. Am J Clin Pathol. 1977 Dec;68(6):729–735. doi: 10.1093/ajcp/68.6.729. [DOI] [PubMed] [Google Scholar]
  25. Lawrie G. M., Lie J. T., Morris G. C., Jr, Beazley H. L. Vein graft patency and intimal proliferation after aortocoronary bypass: early and long-term angiopathologic correlations. Am J Cardiol. 1976 Dec;38(7):856–862. doi: 10.1016/0002-9149(76)90798-0. [DOI] [PubMed] [Google Scholar]
  26. Leisch F., Herbinger W., Brucke P. Coronary artery spasm induced by aortocoronary bypass surgery. Int J Cardiol. 1983;2(5-6):543–545. doi: 10.1016/0167-5273(83)90163-8. [DOI] [PubMed] [Google Scholar]
  27. Lewis B. S., Mitha A. S., Rogers N. M., Gotsman M. S. Late mortality of aortocoronary bypass surgery. S Afr Med J. 1973 Sep 29;47(38):1727–1727. [PubMed] [Google Scholar]
  28. Lie J. T., Lawrie G. M., Morris G. C., Jr, Winters W. L. Hemorrhagic myocardial infarction associated with aortocoronary bypass revascularization. Am Heart J. 1978 Sep;96(3):295–302. doi: 10.1016/0002-8703(78)90039-x. [DOI] [PubMed] [Google Scholar]
  29. Lowe J. Method for the morphometric analysis of arterial structure. J Clin Pathol. 1984 Dec;37(12):1413–1415. doi: 10.1136/jcp.37.12.1413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Marsa R., Mehta S., Willis W., Bailey L. Constrictive pericarditis after myocardial revascularization: report of three cases. Am J Cardiol. 1979 Jul;44(1):177–183. doi: 10.1016/0002-9149(79)90268-6. [DOI] [PubMed] [Google Scholar]
  31. Marti M. C., Bouchardy B., Cox J. N. Aorto-coronary by-pass with autogenous saphenous vein grafts: histopathological aspects. Virchows Arch A Pathol Pathol Anat. 1971;352(3):255–266. doi: 10.1007/BF00600675. [DOI] [PubMed] [Google Scholar]
  32. Meyer J. M., Kleynhans P. H., Verwoerd C. A., Steyn J. G. Coronary artery bypass surgery at the University of the Orange Free State Medical School. S Afr Med J. 1979 Jul 21;56(3):93–98. [PubMed] [Google Scholar]
  33. Olinger G. N., Boerboom L. E., Bonchek L. I., Hutchinson L. D., Kissebah A. H. Hyperkalemia in cardioplegic solutions causing increased cholesterol accumulation in vein grafts. J Thorac Cardiovasc Surg. 1983 Apr;85(4):590–594. [PubMed] [Google Scholar]
  34. Pintar K., Barboriak J. J., Johnson W. D., Co E. D. Atherosclerotic aneurysm in aortocoronary vein graft. Arch Pathol Lab Med. 1978 Jun;102(6):287–288. [PubMed] [Google Scholar]
  35. Rahimtoola S. H. Coronary bypass surgery for chronic angina--1981. A perspective. Circulation. 1982 Feb;65(2):225–241. doi: 10.1161/01.cir.65.2.225. [DOI] [PubMed] [Google Scholar]
  36. Rahimtoola S. H. Coronary bypass surgery for unstable angina. Circulation. 1984 Apr;69(4):842–848. doi: 10.1161/01.cir.69.4.842. [DOI] [PubMed] [Google Scholar]
  37. Robbins J. A., Mohanty P. K., Mohanty L. B. Aortic aspergilloma resulting in supravalvular aortic stenosis after aortocoronary bypass surgery. Am Heart J. 1983 Jul;106(1 Pt 1):163–166. doi: 10.1016/0002-8703(83)90459-3. [DOI] [PubMed] [Google Scholar]
  38. Robers N. M., Bakst A., Lewis B. S., Moyes D. G., Gotsman M. S. Early results of surgery for coronary artery disease. S Afr Med J. 1972 Sep 2;46(35):1247–1253. [PubMed] [Google Scholar]
  39. Roberts W. C., Lachman A. S., Virmani R. Twisting of an aorta-coronary bypass conduit: a complication of coronary surgery. J Thorac Cardiovasc Surg. 1978 May;75(5):772–776. [PubMed] [Google Scholar]
  40. Robinson M. J., Lam R., Morales A. R. Myocardial alterations associated with aortocoronary saphenous vein bypass. Am J Clin Pathol. 1977 Dec;68(6):721–728. doi: 10.1093/ajcp/68.6.721. [DOI] [PubMed] [Google Scholar]
  41. Ross A. M., Hammond G. L., Cohen L. S., Wolfson S. Angiographic evaluation of saphenous vein bypass grafts: artifactual "occlusion" caused by dual sources of flow. Am J Cardiol. 1977 Mar;39(3):384–389. doi: 10.1016/s0002-9149(77)80093-3. [DOI] [PubMed] [Google Scholar]
  42. Saffitz J. E., Ganote C. E., Peterson C. E., Roberts W. C. False aneurysm of ascending aorta after aortocoronary bypass grafting. Am J Cardiol. 1983 Oct 1;52(7):907–909. doi: 10.1016/0002-9149(83)90440-x. [DOI] [PubMed] [Google Scholar]
  43. Schaff H. V., Gersh B. J., Fisher L. D., Frye R. L., Mock M. B., Ryan T. J., Ells R. B., Chaitman B. R., Alderman E. L., Kaiser G. C. Detrimental effect of perioperative myocardial infarction on late survival after coronary artery bypass. Report from the Coronary Artery Surgery Study--CASS. J Thorac Cardiovasc Surg. 1984 Dec;88(6):972–981. [PubMed] [Google Scholar]
  44. Schaff H. V., Orszulak T. A., Gersh B. J., Piehler J. M., Puga F. J., Danielson G. K., Pluth J. R. The morbidity and mortality of reoperation for coronary artery disease and analysis of late results with use of actuarial estimate of event-free interval. J Thorac Cardiovasc Surg. 1983 Apr;85(4):508–515. [PubMed] [Google Scholar]
  45. Schaper J., Schaper W. Reperfusion of ischemic myocardium: ultrastructural and histochemical aspects. J Am Coll Cardiol. 1983 Apr;1(4):1037–1046. doi: 10.1016/s0735-1097(83)80106-5. [DOI] [PubMed] [Google Scholar]
  46. Seides S. F., Borer J. S., Kent K. M., Rosing D. R., McIntosh C. L., Epstein S. E. Long-term anatomic fate of coronary-artery bypass grafts and functional status of patients five years after operation. N Engl J Med. 1978 Jun 1;298(22):1213–1217. doi: 10.1056/NEJM197806012982201. [DOI] [PubMed] [Google Scholar]
  47. Smith S. H., Geer J. C. Morphology of saphenous vein-coronary artery bypass grafts: Seven to 116 months after surgery. Arch Pathol Lab Med. 1983 Jan;107(1):13–18. [PubMed] [Google Scholar]
  48. Speiser K., Rothlin M., Turina M. Comparison between internal mammary artery implantation and aorto-coronary vein bypass grafting in coronary artery disease with significant left anterior descending stenosis. Thorac Cardiovasc Surg. 1983 Feb;31(1):54–57. doi: 10.1055/s-2007-1020295. [DOI] [PubMed] [Google Scholar]
  49. Spray T. L., Roberts W. C. Changes in saphenous veins used as aortocoronary bypass grafts. Am Heart J. 1977 Oct;94(4):500–516. doi: 10.1016/s0002-8703(77)80046-x. [DOI] [PubMed] [Google Scholar]
  50. Spray T. L., Roberts W. C. Status of the grafts and the native coronary arteries proximal and distal to coronary anastomotic sites of aortocoronary bypass grafts. Circulation. 1977 May;55(5):741–749. doi: 10.1161/01.cir.55.5.741. [DOI] [PubMed] [Google Scholar]
  51. Starling M. R., Groves B. M., Frost D., Toon R., Arom K. V. Aorto-coronary vein fistula. A complication of coronary artery bypass graft surgery. Chest. 1981 Jan;79(1):64–68. doi: 10.1378/chest.79.1.64. [DOI] [PubMed] [Google Scholar]
  52. Unni K. K., Kottke B. A., Titus J. L., Frye R. L., Wallace R. B., Brown A. L. Pathologic changes in aortocoronary saphenous vein grafts. Am J Cardiol. 1974 Oct 3;34(5):526–532. doi: 10.1016/0002-9149(74)90122-2. [DOI] [PubMed] [Google Scholar]
  53. Vlodaver Z., Edwards J. E. Editorial: Occlusion of coronary grafts--result of injury? Ann Thorac Surg. 1975 Dec;20(6):719–720. doi: 10.1016/s0003-4975(10)65770-0. [DOI] [PubMed] [Google Scholar]
  54. Vlodaver Z., Edwards J. E. Pathologic analysis in fatal cases following saphenous vein coronary arterial bypass. Chest. 1973 Nov;64(5):555–563. doi: 10.1378/chest.64.5.555. [DOI] [PubMed] [Google Scholar]
  55. Weir E. K., Stevens J. E., Beck W., O'Donovan T. G., Barnard M., Barnard C. N. The management of intractable angina pectoris using saphenous vein bypass grafts. Experience in Cape Town. S Afr Med J. 1974 Jan 5;48(1):13–17. [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES