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ICVTS on-line discussion E Severity of CAD not associated with operative mortality?

Athens University Medical School, 45 Aytokratoros Irakleiou Street, 15122 Marousi, Athens, Greece

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

eComment: I would like to congratulate Dr. Jalal, not only for his effort to provide an objective method for semi-quantification of diffuseness of coronary atherosclerosis but also for bringing this very interesting subject up for discussion [1].

I would like to comment on the issue of mortality associated with the diffuseness of coronary artery disease. According to his unpublished data, operative mortality was no different among patients with various grades of severity of coronary artery disease based on his scoring system. I have no difficulty accepting this since he has excluded patients in whom endarterectomies, on-lay patch arterioplasties or multiple direct or sequential grafts to a single artery were performed. In other words, he has included patients that, regardless of the severity of disease, could be fully revascularized without the additional cross-clamp and bypass time (for the on-pump cases) that is required for more complex procedures and is well known to be associated with increased operative mortality. In this regard, however, the statement ‘diffuseness, if defined properly, has no role in operative mortality’ [2] is somewhat misleading. Apparently, overall severely diffused vessels, many of which require complex bypass techniques, influence unfavorably operative mortality. Therefore, the need for a preoperative evaluation method to grade severity of coronary artery disease reliably and objectively in a manner that allows us to incorporate this parameter in preoperative risk scoring system is still unfulfilled. Providing two otherwise similar patients, one with excellent bypass target vessels and the other with diffusely calcified ones most probably necessitating endarterectomy, with the same probability of operative mortality during informed consent is not right and we have all found ourselves in this awkward situation.

However, Dr. Jalal's grading system which combines preoperative and intraoperative parameters is very welcome in our effort to evaluate objectively the role of disease severity on coronary surgery outcomes.

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1. Jalal A. An objective method for grading of distal disease in the grafted coronary arteries. Interact CardioVasc Thorac Surg doi:10.1510/icvts.2007.156273.[Abstract/Free Full Text]
2. Jalal A. Author's reply to AN Aboul-Azm and MA Iqbal. Interact CardioVasc Thorac Surg 2007; 6:451–457.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dimitrios C. Angouras Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Angouras, D. C. Search for Related Content PubMed PubMed Citation Articles by Angouras, D. C. Related Collections Related Article