Graft failure after CABG

Graft failure after CABG

Potential pointers to graft failure after CABG are the following:

  1. Electrocardiographic signs of myocardial ischemia
  2. Ventricular arrhythmias
  3. Significant elevation of biomarkers
  4. New wall motion abnormalities noted on echocardiography
  5. Hemodynamic instability

Though conventionally, invasive coronary angiography is used for assessment of graft failure, graft angiography is technically more challenging and complications rates are three times higher, though the absolute risk is not very high [1]. Computed tomographic coronary angiography (CT coronary angiography) has improved a lot and is now useful in evaluating bypass grafts.

Multi slice CT coronary angiography can achieve a sensitivity of 98% for detection of graft stenosis or occlusion with a specificity of 97% [2]. It may be difficult to assess patency of distal anastomoses into heavily calcified native vessels. Surgical clips and other artifacts may also cause limitations in CT coronary angiogram interpretations.

References

  1. Nilsson T, Lagerqvist B, Tornvall P. Coronary angiography of patients with a previous coronary artery by-pass operation is associated with a three times increased risk for neurological complications. A report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Scand Cardiovasc J. 2009 Dec;43(6):374-9.
  2. McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiol Ther. 2017 Dec;6(2):203-223.