Coronary artery bypass grafts in 109 autopsied patients. Statistical analysis of graft and anastomosis patency and regional myocardial injury
G. W. Moore and G. M. Hutchins
The natural history of coronary artery bypass grafts (CABGs) is poorly
understood. In 109 hearts with CABGs, examined after postmortem coronary
arteriography and fixation in distention from patients autopsied at The
Johns Hopkins Hospital, we studied the 236 grafted coronary arteries for
graft and anastomosis patency and operative myocardial injury in the
distribution of the distal anastomosis. Of the 30 patients who died at
operation, 71 of 72 (99%) had patent grafts; of 61 who died within one
month, 120 of 131 (92%) had patent grafts; and of 18 who died one to 70
months after surgery 20 of 33 (61%) had patent grafts. The distal
anastomosis site was open in 184 of 211 (87%) patent grafts but in only 13
of 25 (52%) nonpatent grafts. Regional contraction-band necrosis was found
in 83 of 184 (45%) with patent graft and distal anastomosis, but in only 11
of 52 (21%) that were closed. Five closed distal anastomoses, but none that
were open, had coagulation necrosis. Since the introduction of cold
potassium chloride cardioplegia, significantly less regional
contraction-band necrosis (19 of 79) (24%) was found than before (80 of
157) (51%). The results of this study show less CABG patency in long-term
survivors; association of regional contraction-band necrosis with patent
grafts and of coagulation necrosis with closed grafts; and less operative
myocardial injury with current surgical technique.
