Bypass Graft Failure
Changing What We Can, Accepting What We Cannot Change, and Developing the Science to Know the Difference
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- coronary artery disease
- heart failure
- hospital mortality
- myocardial infarction
Coronary bypass graft surgery is a landmark date in the lives of people who need it, marking the transition to significantly improved quality (and often quantity) of life (Figure). Development of bypass graft failure is another landmark date that often signals the beginning of the end. As reported by Iqbal et al1 in this issue of Circulation: Cardiovascular Interventions, mortality during the first year after bypass graft failure is high (5%–9%), well above the 3% threshold, used to define high cardiac risk.
See Article by Iqbal et al
Can the high risk of death (and nonfatal events, such as myocardial infarction and repeat revascularization) be modified? Performing meticulous revascularization of the culprit lesion could minimize the risk of acute and chronic complications originating from that lesion. However, subsequent adverse events can also be caused by coronary artery disease progression at different locations of the culprit graft, at different bypass grafts, or in the native coronary circulation. Patients may also develop noncoronary cardiac diseases, such as progressive heart failure and arrhythmias, or noncardiac diseases, such as cancer or infection (Figure), which cannot be modified by treating the culprit bypass graft lesion or by administering atherosclerosis treatments.
When a patient presents with bypass …