Coronary artery bypass grafting in patients with systemic lupus erythematosus

Abstract

Surgical treatment of coronary artery disease in the systemic lupus erythematosus (SLE) patients has not been comprehensively addressed. The present review aimed to give an overview of coronary artery disease in the SLE patients receiving coronary artery bypass grafting (CABG). The study materials were based on comprehensive literature retrieval, which recruited 17 pertinent articles with 30 patients. No differences were found in the graft patencies between the arterial and venous grafts; and between the early and late patency rates. Pathological inspections revealed that all graft vessels were normal with no signs of SLE-related atherosclerosis or vasculitis, one coronary artery was pathologically normal, and another coronary artery showed vasculitis. The coexisting disorders, including diabetes mellitus, hyperlipidemia, and nephropathy in the SLE patients cause early deterioration of the saphenous vein grafts. Early occlusion of the saphenous vein grafts was also observed in SLE patients. The left anterior descending coronary artery was most commonly affected by SLE and was the most common coronary artery requiring a CABG procedure. The graft vessels, both arterial and venous, rarely degenerated; whereas, early and late graft failure was usually caused by technical failures. The lack of vasculitis and atherosclerosis in the arterial grafts encourage surgeons to prefer to use the arterial grafts in SLE patients. Less invasive surgical technique would favour the patients in terms of long-term outcomes.