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ICVTS on-line discussion F Objective grading system of CA diffuseness is still desirable

Bakoulev Scientific Center, Rublevskoe Shosse 135, Moscow 121552, Russia

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

eComment: Message: high risk patients now represent a substantial part of patients referred for coronary surgery. Preoperational severity of illness in patients undergoing coronary artery bypass grafting (CABG) surgery is a major determinant of clinical postoperative outcomes. Revascularization in patients with diffuse disease is well recognized as an important determinant of patient outcomes.

However, up to today all risk models do not fully account diffuseness (diffuseness score) as a risk factor. In the context of the above mentioned, this paper [1] seems very interesting.

However some questions arise: The term ‘diffuseness’ used in the work encompasses 3 notions:

–diffuse changes in coronary arteries

–distal disease (without distal runoff)

–and small coronaries

Such use of the term seems not quite eligible, as there are small coronary arteries without any diffuse lesions. Besides, the presence of small coronary arteries is absolutely typical for women. Also, the author does not take into account the degree of atherosclerotic lesion of the arterial wall of coronary vessels, and, in particular, the notion of coronary artery calcification.

Secondly, the proposed grading system based on the measurement of the size of the vessels by standard metallic probes of diameters ranging from 1 mm to 2 mm oversimplifies the real situation. Our experience shows that it compromises the possibilities of mathematical analysis and the feasibility of correlation analysis.

Thirdly, the author uses the pulsatility index as an evaluation factor. At the end of the discussion, the author notes that after successful completion of endarterectomies or on-lay patch arterioplasty the flow and pulsatility indexes become as good as in the vessels which had no disease.

We performed an intentional study of myocardial perfusion in patients one year after endarterectomy and revealed decreased perfusion in the pools of endarterectomized arteries in the majority of cases. Hence, it is evident, that pulsatility index, determined immediately after the operation, is hardly usable for prediction purposes.

We must conclude that the impact of diffuseness of coronary artery disease on the outcomes of CABG surgery remain unclear and it is still desirable to develop an objective system of grading the diffuseness of coronary vessels wall injury.

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1. Jalal A. An objective method for grading of distal disease in the grafted coronary arteries. 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): Leo A. Bockeria Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Berishvilli, l. Search for Related Content PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Berishvilli, l. Related Collections Related Article