EFFECTS OF SMALLER PHYSICAL SIZE ON COMPLEX ARTERIAL GRAFTING IN CORONARY-ARTERY OPERATIONS

Background. The trend in coronary artery bypass grafting is for a grad ual transition to the more extensive use of arterial grafts. This stud y was designed to investigate the effects of patient body size on comp lex arterial grafting in coronary artery bypass procedures. Methods. F our hundred forty-five patients who underwent coronary artery bypass g rafting with two or more distal anastomoses using arterial grafts were divided into two groups according to body surface area: group A (n = 114), 1.60 m(2) or less; and group B (n = 331), greater than 1.60 m(2) . Preoperative patient characteristics and early and long-term results were compared between the groups. Results. The prevalence of female s ex (27% in group A versus 0.9% in group B; p < 0.0001) and age (62.7 /- 8.1 years in group A versus 58.9 +/- 7.0 years in group B; p < 0.00 1) were significantly different. However, the prevalence of previous m yocardial infarction and of left ventricular dysfunction and the exten t of coronary artery disease were not significantly different. Three p atients (2.6%) in group A and 3 patients (0.9%) in group B died within 30 days of operation (p = 0.18). The 1-month patency rate of arterial grafts was not significantly different (98.7% versus 96.7%; p = 0.16) , but that of venous grafts was significantly lower in group A than in group B (88.9% versus 97.7%; p = 0.045). No significant difference wa s noted in the 3-year actuarial survival rate (93.8% versus 91.6%). Co nclusions. The extensive use of arterial grafts in patients with small body size was associated with excellent long-term results, with no si gnificant increase in operative mortality or morbidity.