Coronary Artery Bypass Graft (cont.)
What are the long-term results after
CABG surgery?
A very small percentage of vein grafts may become blocked within the first
two
weeks after CABG surgery due to blood clotting. Blood clots form in the grafts
usually because of small arteries beyond the insertion site of the graft causing
sluggish blood run off. Another 10% of vein grafts close off between two weeks and
one year after CABG surgery. Use of aspirin to thin the blood has been shown to
reduce these later closings by 50%. Grafts become narrowed after the first five
years as cells stick to the inner lining and multiply, causing formation of scar
tissue (intimal fibrosis) and actual atherosclerosis. After 10 years, only 2/3
of vein grafts are open and 1/2 of these have at least moderate narrowings.
Internal mammary grafts have a much higher (90%) 10 year rate of remaining open.
This difference in longevity has caused a shift in surgical practices toward
greater use of internal mammary and other arteries as opposed to veins for
bypasses.
Recent data has shown that in CABG patients with elevated LDL cholesterol
(bad cholesterol) levels, use of cholesterol-lowering medications (particularly
the statin family of drugs) to lower LDL levels to below 80 will significantly
improve long-term graft patency as well as improve survival benefit and heart
attack risk. Patients are also advised about the importance of lifestyle changes
to lower their chance of developing further atherosclerosis in their coronary
arteries. These include stopping smoking, exercise, reducing weight and dietary
fat, as well as controlling blood pressure and diabetes. Frequent monitoring of
CABG patients with physiologic testing can identify early problems in grafts.
PTCA (angioplasty) with stenting, in addition to aggressive risk factor modification, may
significantly limit the need for repeat CABG years later. Repeat CABG surgery is
occasionally necessary, but may have a higher risk of complication.
Next: How do CABG surgery and PTCA (angioplasty) compare? »
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