Objective. Few reports exist on the results of coronary artery bypass graft
ing (CABG) in patients with systemic lupus erythematosus (SLE). Methods: We
retrospectively reviewed eight CABG in seven SLE patients. In early and la
te postoperative angiography, all grafts were evaluated for occlusion, deve
lopment of string sign, or presence of significant stenosis. The early and
late results were compared. The pathological studies were performed on the
segments of the internal thoracic artery (ITA) and saphenous vein collected
from each patient. Atherosclerosis of the ITA was analyzed using the subje
ctive evaluation proposed by Kay et al. (Kay HR, Korns ME, Flemma RJ, Tecto
r AJ, Lepley D. Atherosclerosis of the internal mammary artery. Ann Thorac
Surg 21;1976:504-507) scale 0-4 (0 = normal, 1 = minimal disease, 2 = less
than 25% luminal narrowing, 3 = 25-50% narrowing, and 4 = greater than 50%
narrowing). Results: The patients consisted of three men and four women wit
h a mean age of 59.8 years. Co-morbid diseases were frequent and there were
three patients (37.5%) with renal failure (two dialysis patients, one with
renal dysfunction) and two patients with severe atherosclerosis of the aor
ta. The ITA was used in four patients. Saphenous vein graft was used in sev
en patients. Concomitant procedures included aortic valve replacement and m
itral annuloplasty, mitral valvuloplasty and tricuspid annuloplasty, mitral
valve replacement and tricuspid annuloplasty (TAP). There was one hospital
death (12.5%). Early patency rates were 87.5% (21/24). No other atheroscle
rotic changes or stenosis suggesting vasculitis were noted. In pathological
studies, there was no significant atherosclerosis in the six ITA specimens
from four patients, although three patients had degree two atherosclerosis
. No vasculitis was found in ITA or saphenous vein grafts. During the mean
follow-up period of 35.3 months (range, 5-91 months), then was one non-card
iac late death. Late restudy tin three patients, 12, 57 and 64 months later
respectively) revealed no deterioration in either ITA or vein grafts. Over
all prognosis after the operation in SLE patients appears to be good. No ot
her cardiac events were observed, and patients demonstrated marked clinical
improvement. Conclusions: CABG in SLE patients can be performed with accep
table morbidity and mortality. Our data so far reveals no evidence to precl
ude the use of ITA and vein grafts in SLE patients. (C) 1999 Elsevier Scien
ce B.V. All rights reserved.