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October 16, 1981, Vol 246, No. 16 >
ARTICLE | October 16, 1981

Coronary Artery Bypass Grafts in 109 Autopsied Patients: Title and subTitle BreakStatistical Analysis of Graft and Anastomosis Patency and Regional Myocardial Injury FREE

G. William Moore, MD, PhD; Grover M. Hutchins, MD
[+] Author Affiliations

Reprint requests to Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21205 (Dr Hutchins).


JAMA. 1981;246(16):1785-1789. doi:10.1001/jama.1981.03320160017022
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References

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 contractionband necrosis with patent grafts and of coagulation necrosis with closed grafts; and less operative myocardial injury with current surgical technique.

(JAMA 1981;246:1785-1789)

REFERENCES

1 +
McIntosh HD, Garcia JA:  The first decade of aortocoronary bypass grafting, 1967-1977: A review . Circulation 1978;;57:405-431.
2 +
Murphy ML, Hultgren HN, Detre K, et al, and Participants of the Veterans Administration Cooperative Study:  Treatment of chronic stable angina: A preliminary report of survival data of the randomized Veterans Administration Cooperative Study . N Engl J Med 1977;;297:621-627.
3 +
Lawrie GM, Morris GC Jr, Howell JF, et al:  Results of coronary bypass more than five years after operation in 434 patients . Am J Cardiol 1977;;40:665-672.
4 +
Reul GJ Jr, Cooley DA, Wukasch DC, et al:  Long-term survival following coronary artery bypass: Analysis of 4,522 consecutive patients . Arch Surg 1975;;110:1419-1424.
5 +
Assad-Morell JL, Connolly DC, Brandenburg RO, et al:  Aorta-coronary artery saphenous vein bypass grafts . J Thorac Cardiovasc Surg 1975;;69:841-850.
6 +
Selden R, Neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 1975;;293:1329-1333.
7 +
Gott VL:  Outlook for patients after coronary artery revascularization . Am J Cardiol 1974;;33:431-437.
8 +
Ross RS:  Ischemic heart disease: An overview . Am J Cardiol 1975;;36:496-505.
9 +
Favaloro RG, Effler DB, Groves LK, et al:  Severe segmental obstruction of the left main coronary artery and its divisions: Surgical treatment by the saphenous vein graft technique . J Thorac Cardiovasc Surg 1970;;60:469-482.
10 +
Bartel AG, Behar VS, Peter RH, et al:  Exercise stress testing in evaluation of aortocoronary bypass surgery: Report of 123 patients . Circulation 1973;;48:141-148.
11 +
Berndt TB, Miller DG, Silverman JF, et al:  Coronary bypass surgery for unstable angina pectoris: Clinical follow-up and results of postoperative treadmill electrocardiograms . Am J Med 1975;;58:171-176.
12 +
Mnayer M, Chahine RA, Raizner AE:  Mechanisms of angina relief in patients after coronary artery bypass surgery . Br Heart J 1977;;39:605-609.
13 +
Achuff SC, Griffith LSC, Conti CR, et al:  The 'angina-producing' myocardial segment: An approach to the interpretation of results of coronary bypass surgery . Am J Cardiol 1975;; 36:723-733.
14 +
Cohen MV, Gorlin R:  Main left coronary artery disease: Clinical experience from 1964-1974 . Circulation 1975;;52:275-285.
15 +
Zeft HJ, Manley JC, Huston JH, et al:  Left main coronary artery stenosis: Results of coronary bypass surgery . Circulation 1974;;49:68-76.
16 +
Hurst JW, King SB III, Logue RB, et al:  Value of coronary bypass surgery: Controversies in cardiology: Part I . Am J Cardiol 1978;;42:308-329.
17 +
Hammermeister KE, Kennedy JW, Hamilton GW, et al:  Aortocoronary saphenous-vein bypass: Failure of successful grafting to improve resting left ventricular function in chronic angina . N Engl J Med 1974;;290:186-192.
18 +
Levine JA, Bechtel DJ, Gorlin R, et al:  Coronary artery anatomy before and after direct revascularization surgery: Clinical and cinearteriographic studies in 67 selected patients . Am Heart J 1975;;89:561-570.
19 +
Soloff LA:  Effects of coronary bypass procedures . N Engl J Med 1973;;288:1302-1303.
20 +
Spodick DH:  The surgical mystique and the double standard: Controlled trials of medical and surgical therapy for cardiac disease: Analysis, hypothesis, proposal . Am Heart J 1973;; 85:579-583.
21 +
Unni KK, Kottke BA, Titus JL, et al:  Pathologic changes in aortocoronary saphenous vein grafts . Am J Cardiol 1974;;34:526-532.
22 +
Lie JT, Lawrie GM, Morris GC Jr:  Aortocoronary bypass saphenous vein graft atherosclerosis: Anatomic study of 99 vein grafts from normal and hyperlipoproteinemic patients up to 74 months postoperatively . Am J Cardiol 1977;; 40:906-914.
23 +
Bulkley BH, Hutchins GM:  Accelerated 'atherosclerosis': A morphologic study of 97 saphenous vein coronary artery bypass grafts . Circulation 1977;;55:163-169.
24 +
Bulkley BH, Hutchins GM:  Myocardial consequences of coronary artery bypass graft surgery: The paradox of necrosis in areas of revascularization . Circulation 1977;;56:906-913.
25 +
Barboriak JJ, Pintar K, Van Horn DL, et al:  Pathologic findings in the aortocoronary vein grafts: A scanning electron microscope study . Atherosclerosis 1978;;29:69-80.
26 +
Hutchins GM, Anaya OA:  Measurements of cardiac size, chamber volumes and valve orifices at autopsy . Johns Hopkins Med J 1973;; 133:96-106.
27 +
Payne KT, Hutchins GM:  Rapid production of reconstruction drawings from serial sections . Am J Clin Pathol 1973;;60:820-822.
28 +
Griffith LSC, Bulkley BH, Hutchins GM, et al:  Occlusive changes at the coronary arterybypass graft anastomosis . J Thorac Cardiovasc Surg 1977;;73:668-679.
29 +
Hutchins GM, Bulkley BH:  Mechanisms of occlusion of saphenous vein—coronary artery 'jump' grafts . J Thorac Cardiovasc Surg 1977;; 73:660-667.
30 +
Lawrie GM, Lie JT, Morris GC Jr, et al:  Vein graft patency and intimal proliferation after aortocoronary bypass: Early and long-term angiopathologic correlations . Am J Cardiol 1976;; 38:856-862.
31 +
Campeau L, Lesperance J, Corbara F, et al:  Patency of aortocoronary saphenous vein bypass grafts five to seven years after surgery . Can J Surg 1978;;21:118-120.
32 +
Campeau L, Corbara F, Crochet D, et al:  Left main coronary artery stenosis: The influence of aortocoronary bypass surgery on survival . Circulation 1978;;57:1111-1115.
33 +
Hamby RI, Aintablian A, Handler M, et al:  Aortocoronary saphenous vein bypass grafts: Long-term patency, morphologic and blood flow in patients with patent grafts early after surgery . Circulation 1979;;60:901-909.
34 +
Rimm AA, Blumlein S, Barboriak JJ, et al:  The probability of closure in aortocoronary vein bypass grafts . JAMA 1976;;236:2637-2640.
35 +
Hutchins GM, Bulkley BH:  Correlation of myocardial contraction band necrosis and vascular patency: A study of coronary artery bypass graft anastomoses at branch points . Lab Invest 1977;;36:642-648.
36 +
Hutchins GM, Silverman KJ:  Pathology of the stone heart syndrome: Massive myocardial contraction band necrosis and widely patent coronary arteries . Am J Pathol 1979;;95:745-752.

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1 +
McIntosh HD, Garcia JA:  The first decade of aortocoronary bypass grafting, 1967-1977: A review . Circulation 1978;;57:405-431.
2 +
Murphy ML, Hultgren HN, Detre K, et al, and Participants of the Veterans Administration Cooperative Study:  Treatment of chronic stable angina: A preliminary report of survival data of the randomized Veterans Administration Cooperative Study . N Engl J Med 1977;;297:621-627.
3 +
Lawrie GM, Morris GC Jr, Howell JF, et al:  Results of coronary bypass more than five years after operation in 434 patients . Am J Cardiol 1977;;40:665-672.
4 +
Reul GJ Jr, Cooley DA, Wukasch DC, et al:  Long-term survival following coronary artery bypass: Analysis of 4,522 consecutive patients . Arch Surg 1975;;110:1419-1424.
5 +
Assad-Morell JL, Connolly DC, Brandenburg RO, et al:  Aorta-coronary artery saphenous vein bypass grafts . J Thorac Cardiovasc Surg 1975;;69:841-850.
6 +
Selden R, Neill WA, Ritzmann LW, et al:  Medical versus surgical therapy for acute coronary insufficiency: A randomized study . N Engl J Med 1975;;293:1329-1333.
7 +
Gott VL:  Outlook for patients after coronary artery revascularization . Am J Cardiol 1974;;33:431-437.
8 +
Ross RS:  Ischemic heart disease: An overview . Am J Cardiol 1975;;36:496-505.
9 +
Favaloro RG, Effler DB, Groves LK, et al:  Severe segmental obstruction of the left main coronary artery and its divisions: Surgical treatment by the saphenous vein graft technique . J Thorac Cardiovasc Surg 1970;;60:469-482.
10 +
Bartel AG, Behar VS, Peter RH, et al:  Exercise stress testing in evaluation of aortocoronary bypass surgery: Report of 123 patients . Circulation 1973;;48:141-148.
11 +
Berndt TB, Miller DG, Silverman JF, et al:  Coronary bypass surgery for unstable angina pectoris: Clinical follow-up and results of postoperative treadmill electrocardiograms . Am J Med 1975;;58:171-176.
12 +
Mnayer M, Chahine RA, Raizner AE:  Mechanisms of angina relief in patients after coronary artery bypass surgery . Br Heart J 1977;;39:605-609.
13 +
Achuff SC, Griffith LSC, Conti CR, et al:  The 'angina-producing' myocardial segment: An approach to the interpretation of results of coronary bypass surgery . Am J Cardiol 1975;; 36:723-733.
14 +
Cohen MV, Gorlin R:  Main left coronary artery disease: Clinical experience from 1964-1974 . Circulation 1975;;52:275-285.
15 +
Zeft HJ, Manley JC, Huston JH, et al:  Left main coronary artery stenosis: Results of coronary bypass surgery . Circulation 1974;;49:68-76.
16 +
Hurst JW, King SB III, Logue RB, et al:  Value of coronary bypass surgery: Controversies in cardiology: Part I . Am J Cardiol 1978;;42:308-329.
17 +
Hammermeister KE, Kennedy JW, Hamilton GW, et al:  Aortocoronary saphenous-vein bypass: Failure of successful grafting to improve resting left ventricular function in chronic angina . N Engl J Med 1974;;290:186-192.
18 +
Levine JA, Bechtel DJ, Gorlin R, et al:  Coronary artery anatomy before and after direct revascularization surgery: Clinical and cinearteriographic studies in 67 selected patients . Am Heart J 1975;;89:561-570.
19 +
Soloff LA:  Effects of coronary bypass procedures . N Engl J Med 1973;;288:1302-1303.
20 +
Spodick DH:  The surgical mystique and the double standard: Controlled trials of medical and surgical therapy for cardiac disease: Analysis, hypothesis, proposal . Am Heart J 1973;; 85:579-583.
21 +
Unni KK, Kottke BA, Titus JL, et al:  Pathologic changes in aortocoronary saphenous vein grafts . Am J Cardiol 1974;;34:526-532.
22 +
Lie JT, Lawrie GM, Morris GC Jr:  Aortocoronary bypass saphenous vein graft atherosclerosis: Anatomic study of 99 vein grafts from normal and hyperlipoproteinemic patients up to 74 months postoperatively . Am J Cardiol 1977;; 40:906-914.
23 +
Bulkley BH, Hutchins GM:  Accelerated 'atherosclerosis': A morphologic study of 97 saphenous vein coronary artery bypass grafts . Circulation 1977;;55:163-169.
24 +
Bulkley BH, Hutchins GM:  Myocardial consequences of coronary artery bypass graft surgery: The paradox of necrosis in areas of revascularization . Circulation 1977;;56:906-913.
25 +
Barboriak JJ, Pintar K, Van Horn DL, et al:  Pathologic findings in the aortocoronary vein grafts: A scanning electron microscope study . Atherosclerosis 1978;;29:69-80.
26 +
Hutchins GM, Anaya OA:  Measurements of cardiac size, chamber volumes and valve orifices at autopsy . Johns Hopkins Med J 1973;; 133:96-106.
27 +
Payne KT, Hutchins GM:  Rapid production of reconstruction drawings from serial sections . Am J Clin Pathol 1973;;60:820-822.
28 +
Griffith LSC, Bulkley BH, Hutchins GM, et al:  Occlusive changes at the coronary arterybypass graft anastomosis . J Thorac Cardiovasc Surg 1977;;73:668-679.
29 +
Hutchins GM, Bulkley BH:  Mechanisms of occlusion of saphenous vein—coronary artery 'jump' grafts . J Thorac Cardiovasc Surg 1977;; 73:660-667.
30 +
Lawrie GM, Lie JT, Morris GC Jr, et al:  Vein graft patency and intimal proliferation after aortocoronary bypass: Early and long-term angiopathologic correlations . Am J Cardiol 1976;; 38:856-862.
31 +
Campeau L, Lesperance J, Corbara F, et al:  Patency of aortocoronary saphenous vein bypass grafts five to seven years after surgery . Can J Surg 1978;;21:118-120.
32 +
Campeau L, Corbara F, Crochet D, et al:  Left main coronary artery stenosis: The influence of aortocoronary bypass surgery on survival . Circulation 1978;;57:1111-1115.
33 +
Hamby RI, Aintablian A, Handler M, et al:  Aortocoronary saphenous vein bypass grafts: Long-term patency, morphologic and blood flow in patients with patent grafts early after surgery . Circulation 1979;;60:901-909.
34 +
Rimm AA, Blumlein S, Barboriak JJ, et al:  The probability of closure in aortocoronary vein bypass grafts . JAMA 1976;;236:2637-2640.
35 +
Hutchins GM, Bulkley BH:  Correlation of myocardial contraction band necrosis and vascular patency: A study of coronary artery bypass graft anastomoses at branch points . Lab Invest 1977;;36:642-648.
36 +
Hutchins GM, Silverman KJ:  Pathology of the stone heart syndrome: Massive myocardial contraction band necrosis and widely patent coronary arteries . Am J Pathol 1979;;95:745-752.

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