A 54-year-old male with a history of coronary artery disease (CAD), hypertension, and hyperlipidemia presented to the emergency department at NYU Langone Hospital—Tisch Hospital with a burning sensation in his chest and shortness of breath on exertion.
An initial stress electrocardiogram was markedly abnormal with 4 to 5 mm of ST depressions in the inferolateral leads as well as ST elevation in aVR.
A follow-up transthoracic echocardiogram and cardiac catheterization revealed severe multivessel CAD, including blockages in the left main, left anterior descending, circumflex, and right coronary arteries, prompting referral to cardiothoracic surgeon Elias A. Zias, MD, director of NYU Langone Health’s Coronary Artery Bypass Program, for coronary artery bypass grafting (CABG) surgery.
The patient, an active individual who regularly practices hot yoga, had one priority—a durable fix. “He asked, ‘What will keep me out of the hospital for 40 years?’” recalls Dr. Zias. Fortunately, Dr. Zias’s mainstay approach to CABG—complete revascularization with the use of arterial grafts—provided the answer.
“We are one of the few centers that can do all revascularization. A successful operation ensures a patient’s wellbeing for decades to come.”
Elias A. Zias, MD
“The current evidence makes it clear that complete revascularization is the goal for bypass surgery,” Dr. Zias says. “We are one of the few centers that can do all revascularization. A successful operation ensures a patient’s wellbeing for decades to come.”
The Value of Complete Revascularization
Research suggests that patients who undergo CABG and receive multiple arterial grafts have better late graft patency and improved long-term survival, Dr. Zias explains, emphasizing that the long-term survival benefits of CABG are primarily due to complete revascularization.
Another key factor is the use of arterial grafts instead of venous grafts. About a decade after surgery, approximately 50 percent of venous grafts fail, compared to a 2 to 5 percent failure rate for arterial grafts, Dr. Zias says.
“In younger patients who require multiple bypass grafts, long-term patency and survival outcomes are very important,” says Dr. Zias. “Here at NYU Langone, we use mostly arterial grafts due to better long-term outcomes.”
Efficient Procedure, Early Discharge
Dr. Zias and his team efficiently performed the quadruple bypass surgery, achieving total cardiopulmonary bypass and aortic cross-clamp durations of 103 and 93 minutes, respectively.
The patient was extubated in the operating room before being taken to his room. He was out of bed less than three hours after he arrived there.
“Having done so many of these procedures, we are one of the most experienced institutions across the country,” Dr. Zias says. “I was extremely pleased to see the patient get back to his normal activities so quickly.”
