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An objective method for grading of distal disease in the grafted coronary arteries

Division of Cardiothoracic Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia

*Corresponding author. Department of Surgery, College of Medicine, King Khalid University Hospital, PO Box: 7805, Department #37, Riyadh-11472, Saudi Arabia. Tel.: +966 1 4671733/4679353, fax: +966 1 4671581.

E-mail address: anjumjalal1{at}hotmail.com (A. Jalal).

The impact of diffuseness of coronary artery disease on the outcome of coronary bypass grafting remains unclear due to the absence of an objective grading system for diffuseness. This study proposes a system and validates it by transit time flow measurements. All patients operated upon by the author from July 2004 to August 2006 were enrolled in the study. The patients who had procedures other than isolated coronary bypass grafting were excluded. This resulted in a set of 186 (151 male and 35 female) patients with a mean age of 59.55 years. Those vessels which had endarterectomies, on-lay patches, multiple/sequential grafts to a single artery were removed from analysis. The diffuseness of distal disease was graded from 0 to 3 on the basis of (i) the size of vessel and (ii) the number as well as significance of atheromatous lesions distal to the graft. The correlation analysis showed a moderate positive correlation between pulsitility index and grade of diffuseness and a moderate negative correlation between graft flow and grade of diffuseness (P<0.0001). This study shows that the proposed method of grading provides an objective and reliable system for the assessment of severity of distal disease in the grafted coronary arteries.

Key Words: Diffuse coronary artery disease; Transit time flow; Coronary bypass surgery

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