Coronary artery bypass grafting in patients with systemic lupus erythematosus

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.