Factors determining the survival after coronary artery bypass surgery

The most important factor is the left ventricular function. Those with poor left ventricular function have poor survival. Left ventricular function can also deteriorate due to inadequate myocardial protection during surgery. The type of grafts used also has influence on the survival. Live arterial grafts like left internal mammary artery  or dual internal mammary artery grafting give better long term results. Saphenous vein grafts in general give poorer long term results. But it may not be always feasible to harvest the left internal mammary artery in an emergency surgery, due to time constraints. Progression of native vessel disease as well as graft occlusions affect the survival adversely. Good control of coronary risk factors go a long way in improving the prognosis after coronary artery bypass grafting. Regular monitoring for graft failure and repeat revascularisation either by percutaneous techniques or by repeat surgery are feasible options. Percutaneous intervention could be either for the native vessels or for the grafts. The former gives better results as treatment of venous graft disease is more likely to produce distal embolization and mandates the use of distal protection devices.

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