The Annals of Thoracic Surgery, Vol 54, 894-897, Copyright © 1992 by The Society of Thoracic Surgeons
Surgical considerations in bypassing coronary arteries with 100% proximal occlusion
TR McLean, LG Svensson, B Stein, AC Beall Jr and JI Thornby
Cora and Webb Madding Department of Surgery, Baylor College of Medicine, Houston, Texas.
Objective data on the ability of cineangiography to predict the size of
reconstituted totally occluded coronary arteries, as well as the clinical
outcome of such revascularization, are sparse. Accordingly, we reviewed 200
consecutive cases of coronary revascularization to determine the answers to
these questions. Group I patients (n = 57, with 86 totally occluded
coronary arteries) had at least one coronary artery with a 100% proximal
occlusion that reconstituted distally. Group II patients (n = 143, with 205
subtotally occluded coronary arteries) had 50% to 99% proximal stenosis of
at least one coronary artery. Cineangiograms were blindly reviewed to
measure the size of the coronary arteries, which were compared with the
actual vessel size at operation. In group I, the totally occluded coronary
arteries had a cineangiographic size of 1.9 +/- 0.7 mm and an actual size
of 1.6 +/- 0.4 mm (p = 0.00004). In group II, the subtotally occluded
coronary arteries had a cineangiographic size of 1.8 +/- 0.4 mm compared
with an actual size of 1.8 +/- 0.3 mm (p = not significant). The site of
bypass grafting was significantly smaller in group I (1.6 +/- 0.4 mm versus
1.8 +/- 0.3 mm; p = 0.00008). The two groups were similar with respect to
preoperative and intraoperative parameters. Operative mortalities were
similar (group I, 1.8%; group II, 3.5%; p = 0.68). Creatine kinase
isoenzyme profiles and electrocardiographic changes were similar, except
for a significant late rise of creatine kinase-MB in group I (56.1 +/- 14.7
versus 30.7 +/- 33.7 MIU/mL; p < 0.001). In conclusion, cineangiography
significantly overestimates the size of totally occluded coronary
arteries.(ABSTRACT TRUNCATED AT 250 WORDS)
