Effects of Smaller Physical Size on Complex Arterial Grafting in Coronary Artery Operations

Background. The trend in coronary artery bypass grafting is for a gradual transition to the more extensive use of arterial grafts. This study was designed to investigate the effects of patient body size on complex arterial grafting in coronary artery bypass procedures. Methods. Four hundred forty-five patients who underwent coronary artery bypass grafting 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 m2 or less; and group B (n = 331), greater than 1.60 m2. Preoperative patient characteristics and early and long-term results were compared between the groups. Results. The prevalence of female sex (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 < 0.001) were significantly different. However, the prevalence of previous myocardial infarction and of left ventricular dysfunction and the extent of coronary artery disease were not significantly different. Three patients (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 was noted in the 3-year actuarial survival rate (93.8% versus 91.6%). Conclusions. The extensive use of arterial grafts in patients with small body size was associated with excellent long-term results, with no significant increase in operative mortality or morbidity. (Ann Thorac Surg 1996;62:733–6)