Descriptive Analysis of Early Graft Failure After Coronary Artery Bypass Grafting

All articles of this category (opens in new window) Background: Early graft failure (EGF) is a severe complication after coronary artery bypass grafting (CABG). The clinical course of patients with EGFs was analyzed to evaluate our standard perioperative management in CABG patients. Methods: Between May 2020 and April 2023, a total of 1,630 consecutive patients received an isolated CABG. In total, 1,512 patients (92.8%) underwent an on-pump CABG (ONCAB) and 118 (7.2%) underwent an off-pump CABG (OPCAB). We performed routine intraoperative transit time flow measurement (TTFM). At our institute, postoperative coronary angiography (CAG) was done in patients with (1) newly abnormal electrocardiograms, (2) elevation of postoperative myocardial enzymes on regular check-ups, or (3) hemodynamic instability. We performed descriptive and comparative analyses of the patients’ characteristics using a single-center retrospective approach. Results: A total of 79 (4.8%) patients underwent CAG with suspicion of postoperative myocardial infarction. CAG was performed at a median postoperative time of 8.3 hours. EGFs were diagnosed in 43 (2.6%) patients. In these 43 patients, 32 patients had an EGF of 1 bypass, 10 patients had an EGF of 2 bypasses, and 1 patient had an EGF of 3 bypasses. The most frequent bypass configuration with EGF was the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) in 20 (1.3%) patients (46.5% in 43 EGF patients). The main reason for EGFs in the LIMA to LAD bypass was graft thrombosis, occlusion, or stenosis at the anastomosis ( n = 10), followed by insufficient run-off of distal native coronary arteries ( n = 6) and extrinsic compression of grafts ( n = 4). In an unmatched analysis, the incidence of EGFs indicated no difference in patients undergoing ONCAB compared to OPCAB (ONCAB vs. OPCAB; 2.4% ( n = 37/1,512) vs. 5.1% ( n = 6/118), p = 0.12). In-hospital mortality was considerably high in patients with EGF, with 11.6% ( n = 5/43). Conclusion: Our results showed that EGFs were still found in several cases despite the routine use of TTFM. Regardless of the early detection of EGFs, this complication is accompanied by a high mortality rate. More attention is needed to prevent the development of EGFs in the future, especially in the LIMA-LAD bypass configuration. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany