Our Summary

This research aimed to investigate the relationship between chronic total blockages (CTOs) in the heart’s blood vessels and the outcomes of coronary artery bypass grafting (CABG), a type of heart surgery. The study analyzed previous trial data from veterans undergoing this type of surgery. Patients were divided into groups based on whether they had at least one CTO (a completely blocked blood vessel) and if all CTOs were bypassed during surgery. The main outcomes considered were major cardiac adverse events (MACE).

The study found that nearly 40% of the patients had at least one CTO. During the follow-up period of about 4.7 years, there was no significant difference in the rates of MACE between patients who had a CTO and those who did not. Similarly, there was no significant difference in MACE rates between patients who had all their CTOs bypassed and those who did not.

However, in a specific group of patients - those with dominant right coronary arteries undergoing surgery on the left anterior descending artery - bypassing a CTO in the right coronary artery was associated with significantly lower death rates.

Overall, the presence of CTOs or their complete bypass during surgery did not significantly affect the rates of major heart-related adverse events. But, the possible survival benefit observed in a specific subgroup of patients needs further investigation.

FAQs

  1. What was the main purpose of this research about coronary artery bypass grafting?
  2. Is there a significant difference in the rates of major cardiac adverse events (MACE) between patients with chronic total blockages (CTOs) and those without?
  3. Was there a specific group of patients that benefited more from bypassing a CTO during surgery?

Doctor’s Tip

Based on this research, a doctor may advise a patient undergoing coronary artery bypass surgery that the presence of chronic total blockages in the heart’s blood vessels may not significantly impact the overall outcomes of the surgery. However, in certain cases, such as in patients with dominant right coronary arteries undergoing surgery on the left anterior descending artery, bypassing a CTO in the right coronary artery may lead to improved survival rates. It is important for patients to discuss their individual circumstances and potential risks and benefits with their healthcare provider before undergoing surgery.

Suitable For

Patients who are typically recommended for coronary artery bypass grafting (CABG) include those with severe coronary artery disease, particularly those with significant blockages in the blood vessels supplying the heart. This may include patients with:

  1. Multiple blockages in the coronary arteries
  2. Chronic total occlusions (CTOs) in one or more coronary arteries
  3. Left main coronary artery disease
  4. Severe narrowing of the left anterior descending artery
  5. Unstable angina or acute coronary syndrome
  6. Failed previous interventions such as angioplasty or stenting
  7. Patients with diabetes or other high-risk factors for heart disease
  8. Patients with reduced heart function or heart failure

It is important for patients to undergo a thorough evaluation by a cardiologist and cardiac surgeon to determine if CABG is the best treatment option for their specific condition. The decision to recommend CABG will take into account the severity of the blockages, the patient’s overall health and risk factors, and the potential benefits and risks of the surgery.

Timeline

Before coronary artery bypass surgery:

  1. Patient undergoes diagnostic tests such as coronary angiography to determine the extent of blockages in the heart’s blood vessels.
  2. Patient may undergo medical management to control symptoms and reduce the risk of complications.
  3. Patient may receive counseling and education on the procedure and post-operative care.

During coronary artery bypass surgery:

  1. Surgeon harvests blood vessels from other parts of the body to use as grafts for bypassing blocked coronary arteries.
  2. Patient is placed under anesthesia and the chest is opened to access the heart.
  3. Bypass grafts are attached to the blocked coronary arteries to create new pathways for blood flow.
  4. Patient is monitored closely during and after the surgery for any complications.

After coronary artery bypass surgery:

  1. Patient is transferred to the intensive care unit for monitoring and recovery.
  2. Patient is gradually weaned off medications and support devices as they recover.
  3. Patient undergoes cardiac rehabilitation to improve heart health and recovery.
  4. Patient follows a strict medication regimen and lifestyle changes to prevent future heart problems.
  5. Patient attends regular follow-up appointments with their healthcare provider to monitor their progress and adjust treatment as needed.

What to Ask Your Doctor

  1. Should I be concerned about having chronic total blockages in my heart’s blood vessels?
  2. Will the presence of CTOs affect the outcome of my coronary artery bypass surgery?
  3. Will all my CTOs be bypassed during the surgery?
  4. Are there any specific risks or complications associated with bypassing CTOs during surgery?
  5. What are the potential benefits of bypassing CTOs during surgery?
  6. Are there any alternative treatment options for CTOs besides bypass surgery?
  7. How will having CTOs impact my recovery and long-term prognosis after surgery?
  8. Are there any lifestyle changes or medications I should consider to manage CTOs after surgery?
  9. Will I need additional monitoring or follow-up care for my CTOs after surgery?
  10. Are there any specific factors, such as the location of the CTOs, that may affect the outcome of my surgery?

Reference

Authors: Gikandi A, Stock EM, Dematt E, Quin J, Hirji S, Biswas K, Zenati MA. Journal: J Thorac Cardiovasc Surg. 2025 Jul;170(1):216-227.e3. doi: 10.1016/j.jtcvs.2024.08.016. Epub 2024 Aug 21. PMID: 39173708