OBJECTIVE

To compare the early and long-term results of coronary artery bypass grafting (CABG) in patients with coronary artery (CA) diameter less than 1.5 mm compared to those with larger vessels.

MATERIAL AND METHODS

The results of CABG were studied in 2 groups of patients: the study group (n=100) — multiple lesions of CA with a diameter of less than 1.5 mm within the anastomosis site; the control group (n=100) — patients with CA diameter >1.5 mm. The main group was divided into 2 subgroups — patients with CA ≤1.5 mm (n=61) and ≤1 mm (n=39). Patients with suspected angina pectoris underwent postoperative CT or angiography.

RESULTS

The only perioperative myocardial infarction with lethal outcome was diagnosed in the group with CA ≤1 mm. A year later, there were 6 cases (11.3%) of recurrent angina pectoris NYHA class >I in patients with CA ≤1.5 mm, 11 cases (30.6%) in patients with CA ≤1 mm and 8 cases in patients with CA >1.5 mm (9.2%). Two (3.8%) patients died in the group with CA ≤1.5 mm and 1 patient (2.7%) in the group with CA ≤1 mm. No mortality was observed in the control group. Incidence of repeated revascularizations was similar (1 (1.9%) patient with CA ≤1.5 mm, 1 (2.9%) patient with CA ≤1 mm and 2 (2.3%) patients in the control group). According to CT-angiography data, there were 8 cases of unsatisfactory results in patients with CA ≤1.5 mm and 9 cases — to the CA ≤1 mm. In the control group, there were 7 cases of autovenous bypasses with unsatisfactory flow to CA >1.5 mm and 1 case of venous graft occlusion to CA ≤1 mm.

CONCLUSION

Our study demonstrates an efficacy of complete myocardial revascularization in patients with coronary arteries ≤1.5 mm. At the same time, CABG for lesions of coronary arteries ≤1 mm showed worse in-hospital results and higher incidence of graft occlusions in postoperative period. Therefore, further development of surgical technique for revascularization of coronary arteries ≤1 mm is required.