الفهرس 
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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.
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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
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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.
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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.