[Changes of autologous coronary vessels and aortocoronary grafts in patients with ischemic heart disease after coronary artery bypass grafting].

Aim: 1) to assess effect of coronary lesion morphology on changes of grafts during first year after surgery; 2) to study the state of native coronary vascular bed during first year after surgery; 3) to elucidate special features of atherosclerosis in grafts and coronary arteries in remote period after surgery.

Material And Methods: One hundred eighty seven patients with 3-vessel coronary artery disease subjected to aorto-coronary or mammary-coronary grafting.

Results And Conclusion: Proportions of closed venous grafts were 24,2% among grafts to arteries with 50-75% stenoses, 13.1% among grafts to occluded arteries (p=0.023), and 20.1% among grafts to arteries with 75-99% stenoses. Among venous grafts to arteries with lumen diameter <1.5 mm 30.4% were occluded what was significantly more than among grafts to vessels with 1.5-2.5 mm (15.5%, p=0.003) and >2.5 mm (14.5%, p=0.004) diameter. Morphological risk factors of venous graft closure in immediate postoperative period were 50-75% stenosis and lumen diameter <1.5 mm. All mammary-coronary anastomoses were patent in 1 year, 99% of them remained patent 5 years after surgery. No relationship was found between patency of venous grafts after 5 years of follow-up and morphological characteristics (lumen diameter and percent stenosis) of bypassed arteries. During first year there was no significant differences between patients with patent and occluded grafts both in incidences of novel atherosclerotic lesions (10.4 and 10.3%, respectively, p=0.943) and proportion of closures of initially stenotic arteries (9.6 and 10.3%, respectively, p=0.085). After 5 years novel atherosclerotic lesions were found in 31.9 and 33.6% of patients with patent and occluded grafts, respectively (p=0.910). Complete occlusions of stenosed vessels proximal to anastomosis occurred more often among patients with patent than with occluded grafts (28.6 and 15.9%, respectively, p=0.047). Thus in remote postoperative period development of atherosclerosis in proximal segments of arteries with patent grafts was more 'aggressive' than in arteries with occluded grafts.