Cardiac Surgery/Hybrid Revascularization
Percutaneous Coronary Intervention of Saphenous Vein Graft in Post CABG Patient- Outcome Experiences at Our Center- SVG to OM are More Likely to Develop Occlusion
Ahm Waliul Islam1, Shams Munwar1, A. Q. M. Reza1, Shahab Uddin Talukder1, Tamzeed Ahmed1, Kazi Atiqur Rahman1
Evercare Hospital Dhaka, Bangladesh1
PCI intervention of obstructed & atheromatous venous graft is a real challenge for interventionist to deal with as SVG PCI patients are usually older with significant coronary & noncoronary comorbidities. SVG usually present a degenerate pattern of atherosclerosis with complex friable thrombosis-prone lesions. Higher risk of Distal embolization, Poorer long-term outcome with Higher ISRrate.
In the current era, with the advent and availability of different Drug-Eluting Stents, PCI of SVG vessels is an alternative to re-do surgery for the occlusion of graft vessel. Although, PCI is associated with higher risk of in-stent restenosis, target vessel repeat revascularization, myocardial infarction or death. Uses of embolic protection devices is class I indication by ACC/AHA for SVG PCI. Therefore, we have carried out this prospective study, to see the outcomes of SVG vessel PCI at our center.
Patients were enrolled in this observational non-randomized prospective cohort, who underwent routine CAGfor the post CABG angina, shortness of breath, dyspnea on minimal exertion or hospital admission with MI, NSTMI, Angina II-III and planned for PCI of occluded graft vessel. Total 50 patient were enrolled in this study. Distal protection devices were not used in most of the cases as financial costing is an issue.
Total 46 patient were enrolled in this observational study. Average age of the patient population was(62.1±
10.8), Female 3(6.5%): Male 43(93.5%),BMI (24.9±
2.9). Among the CAD risk factors; DM 30(60%), HTN 34(68%), Dyslipidemia 31(62%), Smoking 12(6%) And FH9(18%). Graft vessel occlusion occurred average (11.5+5.4 Yrs.) after CABG. SVG to OM is the commonest vessel, that developed significant stenosis in 27(56%), followed by LAD 9(16.1%), RCA6(10.7%), PDA 6(10.7%), PLB 3(5.4%), DG 3(5.4%)m and LIMA-LAD 1(1.8%). Total 63stents were deployed in 56 vessels of 46 patients. Double or overlapping stents were deployed; two stents in 11 (17.5%) and three stents in 1 (2%) vessel. One patient had recurrent ISR of SVG-OM stents and had PCI at our center and elsewhere. Common DES were, Sirolimus 25(39.7%), Everolimus 22(34.9%), BMS9(14.3%), Zotarolimus 3 (4.8%). Average stent size was 3.3mm in Diameter. Total3 (6%) patient died, in 1 month to 2yrs after the procedure. No acute or late complications noted in this small group of patients and doing well at 12-24months OPD follow-up.
We found that our patients developed graft vessel occlusion on an average 11yrs, after CABG. OM is the commonest territory to developed significant stenosis. PCI of SVG survival outcome was 93.5% (43 patient) patient in this very primitive observational cohort and doing well with OPD follow-up. Thus, we recommend percutaneous coronary intervention of occluded or stenosed graft vessel as an alternative to re-do surgery in this part of world.