Clopidogrel After Coronary Artery Bypass Graft Surgery

Journal of the American College of Cardiology (Impact Factor: 16.5). 08/2011; 58(10):1084-5; author reply 1085-6. DOI: 10.1016/j.jacc.2011.03.059
Source: PubMed

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    ABSTRACT: Aortocoronary saphenous vein graft is an effective treatment of coronary artery disease and a means of markedly improving long-term prognosis in certain patient subgroups. However, there is a significant failure rate with these conduits. Early failure occurs within the first 1-2 months, most likely from primary thrombosis. Intermediate failure is usually caused by the development of neointimal hyperplasia. Late failure occurs after 3-5 years and results from accelerated atherosclerosis. The impact of saphenous vein graft failure on cardiovascular outcomes is significant, and it is important to implement appropriate therapeutic strategies to prevent or minimize failure rates.
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    ABSTRACT: Minimally invasive coronary artery bypass grafting is safe and widely applicable, and may be associated with fewer transfusions and infections, and better recovery than standard coronary artery bypass grafting. However, graft patency rates remain unknown. The Minimally Invasive Coronary Artery Bypass Grafting Patency Study prospectively evaluated angiographic graft patency 6 months after minimally invasive coronary artery bypass grafting. In this dual-center study, 91 patients were prospectively enrolled to undergo minimally invasive coronary artery bypass grafting via a 4- to 7-cm left thoracotomy approach. The left internal thoracic artery, the ascending aorta for proximal anastomoses, and all coronary targets were directly accessed without endoscopic or robotic assistance. The study primary outcome was graft patency at 6 months, using 64-slice computed tomography angiography. Secondary outcomes included conversions to sternotomy and major adverse cardiovascular events (Clinical Trial Registration Unique identifier: NCT01334866). The mean age of patients was 64 ± 8 years, the mean ejection fraction was 51% ± 11%, and there were 10 female patients (11%) in the study. Surgeries were performed entirely off-pump in 68 patients (76%). Complete revascularization was achieved in all patients, and the median number of grafts was 3. There was no perioperative mortality, no conversion to sternotomy, and 2 reopenings for bleeding. Transfusion occurred in 24 patients (26%). The median length of hospital stay was 4 days, and all patients were followed to 6 months, with no mortality or major adverse cardiovascular events. Six-month computed tomography angiographic graft patency was 92% for all grafts and 100% for left internal thoracic artery grafts. Minimally invasive coronary artery bypass grafting is safe, feasible, and associated with excellent outcomes and graft patency at 6 months post-surgery.
    No preview · Article · Oct 2013 · The Journal of thoracic and cardiovascular surgery