Lipids and Lipid-Lowering Drugs and Graft Function
There is a relationship between the type of graft changes and the time since operation. (a) Thrombotic events are almost exclusively responsible for early graft closures and account for an attrition rate of 10% by 1 month after operation . (b) By the end of the first postoperative year a further 10% loss of patent bypasses has occurred because of intimal fibromuscular hypertrophy. (c) Atherosclerotic plaque, in contrast, is not detectable prior to the end of the first year after operation and is rarely observed before the end of the second or third year [1, 2, 23, 30-32]. Plaques are observed histologically in 21% of grafts at a mean of 5 years after operation; about one-third of grafts at this time have more than 75% atherosclerotic obstructions, and a further one-third have total occlusions secondary to atherosclerosis. In one study, atherosclerosis — defined as intimal foam cell accumulation or frank plaques — was found only 39 or more months after operation and was present in 79% of such cases . Consistent with the temporal sequence of graft changes, all atherosclerotic grafts show some degree of intimal fibromuscular proliferation.
KeywordsCholesteryl Ester Cholesteryl Ester Transfer Protein Internal Mammary Artery Saphenous Vein Graft Hepatic Lipase
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- 10.Bourassa MG, Fisher LD, Campeau L (1985) Long-term fate of bypass grafts. The Coronary Artery Surgery Study and Montreal Heart Institute experiences. Circulation 72: V–71–V–78.Google Scholar
- 11.Bourassa MG, Campeau L, Lesperance J (1991) Changes in grafts and in coronary arteries after coronary bypass surgery. In: Waters DD, Bourassa MG (eds) Care of the patient with previous coronary bypass surgery. Cardiovascular clinics 21/2. Davis, Philadelphia, pp 83–100.Google Scholar
- 12.Campeau L, Enjalbert M, Lesperance J (1983) Atherosclerosis and late closure of aortocoronary saphenous vein grafts. Sequential angiographie studies at 2 weeks, 1 year, 5 to 7 years, and 10 to 12 years after surgery. Circulation 68: 11–1–11–7.Google Scholar
- 13.Campeau L, Enjalbert M, Lesperance J (1984) The relation of risk factors to the development of atherosclerosis in saphenous vein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery. N Engl J Med 311: 1329–1332.PubMedCrossRefGoogle Scholar
- 14.Cameron A, Kemp HG Jr, Green GE (1986) Bypass surgery with the internal mammary artery graft 15 year follow-up. Circulation 74: 111–30–111–36.Google Scholar
- 16.European Coronary Surgery Study Group (1982) Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 2: 1173–1180.Google Scholar
- 19.Grondin CM, Campeau L, Lesperance J (1984) Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation 70: 208–212.Google Scholar
- 21.Havel RJ, Kane JP (1989) Structure and metabolism of plasma lipoproteins. In: Scriver CR, Beaudet AL, Sly WS, Valle D (eds) Metabolic basis of inherited disease. McGraw-Hill, New York, pp 1129–1138.Google Scholar