Coronary artery bypass grafting

Objectives: The aim of this study was to analyze the long-term results of coronary artery bypass grafting in Japanese patients who were followed more than 10 years after surgery, and, without resorting to actuarial methods, to determine the factors that influence long-term survival.Subjects and Methods: From January 1984 through December 1986, 376 patients received coronary artery bypass grafting at the Department of Cardiothoracic Surgery of Juntendo University; it is these patients who comprise the subject of this study. Of the 376 patients, 328 were males (87.2%) and the mean patient age was 58.5 years (range: 32 to 78 years). Single vessel disease was present in 36 patients (10.8%), double vessel disease in 89 patients (26.7%), triple vessel disease in 150 patients (45.0%) and 58 patients (17.4%) with 50% of more stenosis of the left main coronary artery. The mean number of grafts used was 2.3 grafts per patient, while internal thoracic artery conduits were used in 66 patients (17.6%).Results: The 10-year survival rate for the entire series of patients was 81.4%. Patients receiving internal thoraci? artery grafts had a 10-year survival rate of 94.0%, superior to the 78.0% rate found in patients who received only saphenous vein grafts. Other risk factors associated with reduced survival rates, besides non-use of internal thoracic artery, were: advanced age, diabetes mellitus, hypertension, presence of left main coronary artery disease, and severely impaired left ventricular function. The 10-year cardiac event free rate in the total group was 80.4%. Of 70 patients who died during the follow-up period, 19 deaths were due to cardiac causes (27.1%), 19 due to malignant neoplasm (27.1%) and 13 due to cerebral vascular accident (18.6%).Conclusions: Univariate analysis revealed that: the use of only saphenous vein grafts (P=0.0055), advanced age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P=0.0282), presence of left main coronary artery disease (P=0.0140), and severely impaired left ventricular function (P=0.0075) are associated with reduced survival in patients undergoing coronary artery bypass grafting in this cohort of patients.