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Abstract Coronary artery bypass grafting (CABG) has been established as a standard treatment for patients with complex coronary artery disease as it results in excellent long-term survival. CABG has comparative advantages, especially concerning its lower repeat revascularization rate. However its effectiveness is limited by recurrent symptoms caused by failure of the conduits or progression of the atherosclerosis in the native vessels, estimated to affect more than half of patients by 25 years postoperatively. Unlikely, data regarding atherosclerosis progression in surgically bypassed native coronary arteries are less clear and derived mainly from studies conducted >3 decades ago, before the use of the left IMA and radial grafts and widespread statin use. Some studies have demonstrated accelerated atherosclerosis progression that was as much as 10 times as frequent in bypassed arteries as in comparable arteries that were not bypassed. Other studies showed regression of coronary atherosclerosis in bypassed coronaries rather than that not bypassed. At present, the diagnostic method of choice in this situation is invasive coronary angiography to investigate native coronary arteries. However, it is an invasive procedure, with 0.1% mortality and risk of minor or even major complications. Noninvasive techniques such as multi-slice computed tomography (MSCT), can be useful imaging technique able to evaluate progression of Coronary artery disease. 64 Summary In last decades MSCT has developed much more times and has value in CABG patients in predicting all-cause morbidity and mortality. The sensitivity and specificity for the detection of > 50 % graft stenosis were 97.2 % and 97.5 %, respectively. The negative and positive predictive values were 93.6 % and 99 %, respectively. The aim of this study was to assess effect of coronary artery bypass grafting using different conduits on the progression of native coronaries atherosclerosis. This prospective study was carried out on 25 patients who were diagnosed to have ischemic heart disease in cardiothoracic surgery department in Faculty of Medicine Menoufia University. These patients underwent coronary artery bypass grafting (CABG) using different types of conduits (LIMA, RIMA, radial artery, saphenous vein graft). Inclusion criteria: Patients who were indicated for CABG. Exclusion criteria: Associated other cardiac operative procedures (e.g. mitral valve repair or replacement, tricuspid valve repair or replacement and aortic valve replacement surgery). Previous open heart surgery. Emergency CABG 65 Summary All patients were subjected to: 1. Pre-operative data Full history taking: including all personal & demographic data, analysis of the complaint, risk factors & complete past & family history. Full clinical examination: general and local examination. Investigations: Radiological: Coronary Angiography, CT coronary angiography, echocardiography and chest x-ray. Laboratory: complete blood count, liver function tests, kidney function tests, coagulation profile and glycated hemoglobin (Hb A1 C). 2. Operative data: Coronary artery bypass grafting using different conduits, name and numbers of coronaries bypassed, name and number of conduits used. Operation time, total bypass time, cross clamp time and units of blood needed to be transfused. 3. Post-operative data: Duration of mechanical ventilation, ICU stay, hospital stay Total blood drainage after CABG Use of Intra-aortic balloon Outpatient follow up of the patients. Echocardiography, ECG and chest x-ray were ordered in the first visit after one week of discharge. 66 Summary CT coronary angiography to evaluate progression of atherosclerosis at the end of follow up period (after 6 months) or if indicated before 6 months. Analysis of coronary artery atherosclerosis was done on native coronaries on both studies (pre-operative and 6 months post-operative) to clarify the progression of native atherosclerosis either bypassed or not. The results of our present study can be summarized as follows: In this study there was male predominance (76%) among the studied cases. Regarding age ranged between 47 and 63 with mean (55.04 ± 4.83) and median [55.0 (51.0 – 59.0)]. The current study showed that according to the risk factors among the studied cases, smoking was (60%), Dyslipidemia was (32%), HTN was (32%) and Diabetes was (32%). The results showed that according to grafts in proximal lesions, in LAD, regression was (0.0%), progression was (68%) and same was (32%). In Diag, regression was (0.0%), progression was (88.9%) and same was (11.1%). In OM, regression was (0.0%), progression was (90%) and same was (10%). In PDA, regression was (0.0%), progression was (75%) and same was (25%). In Distal lesions, in LAD, regression was (96%), progression was (4%) and same was (0%). In Diag, regression was (100.0%), progression was (0%) and same was (0%). In OM, regression was (90.0%), progression was (10%) and same was (0%). In PDA, regression was (75%), progression was (25%) and same was (0.0%). Also, there was statistically significant difference between proximal with distal lesion according to grafts. 67 Summary This study showed that there was no statistically significant difference between LAD grafts with other grafts (Diag, OM, PDA) regarding proximal and distal lesion. There was no statistically significant difference between left system (LAD, D, OM) with right system (PDA) regarding proximal lesion. While there was statistically significant difference between left system (LAD, D, OM) with right system (PDA) regarding distal lesion. Our results showed that according to postoperative course, ICU stay ranged between 1 and 4 with mean (2.0 ± 0.71) and with median (2.0 (2.0 – 2.0)). Blood drainage ranged between 210 and 1150 with mean (416.0 ± 210.2) and with median (360.0 (280.0 – 420.0)). Blood unit 1 was (24%), 2 was (64%) and unit 3 was (12%). Cases who had reoperation were (8%). Our results showed that univariate logistic regression analysis for progression in distal lesion regarding the parameters there was no statistically significant difference. While there was statistically significant difference regarding Dyslipidemia and Diabetes. Regression was (27%) and Progression was (28.6%) regarding Smoking. |