Bypass Graft Failure

Coronary bypass graft surgery is a landmark date in the lives of people who need it, marking the transition to significantly improved quality (and often quantity) of life (Figure). Development of bypass graft failure is another landmark date that often signals the beginning of the end. As reported by Iqbal et al1 in this issue of Circulation: Cardiovascular Interventions , mortality during the first year after bypass graft failure is high (5%–9%), well above the 3% threshold, used to define high cardiac risk.Figure. Overview of various treatments during the entire lifespan of patients who undergo coronary bypass graft surgery (CABG). DES indicates drug-eluting stent; EPD, embolic protection device; GP IIb/IIIa, glycoprotein IIb/IIIa inhibitors; PCI, percutaneous coronary intervention; PCSK9i, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors; P2Y12i, P2Y12 platelet receptor antagonists; and SVG, saphenous vein graft.See Article by Iqbal et al Can the high risk of death (and nonfatal events, such as myocardial infarction and repeat revascularization) be modified? Performing meticulous revascularization of the culprit lesion could minimize the risk of acute and chronic complications originating from that lesion. However, subsequent adverse events can also be caused by coronary artery disease progression at different locations of the culprit graft, at different bypass grafts, or in the native coronary circulation. Patients may also develop noncoronary cardiac diseases, such as progressive heart failure and arrhythmias, or noncardiac diseases, such as cancer or infection (Figure), which cannot be modified by treating the culprit bypass graft lesion or by administering atherosclerosis treatments.When a patient presents with bypass …