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Zhang W, Wu H. Outcomes of coronary artery bypass grafting with coronary endarterectomy: A systematic review and meta-analysis of recent studies. Perfusion 2024; 39:489-498. [PMID: 36530039 DOI: 10.1177/02676591221147418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Objective: The aim of this systematic review and meta-analysis was to evaluate the short-term and long-term outcomes of coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) versus isolated CABG.Methods: Studies evaluating outcomes of CABG with CE (CE-CABG) were searched from 1 January 2000 to 30 September 2022, on PubMed, Embase, and Cochrane databases. The primary outcome was 30 -days mortality. Secondary outcomes were postoperative myocardial infraction, low output syndrome, cardiac arrhythmia, renal dysfunction, and 5 years survival.Results: A total of 12 observational studies including 114,319 patients assessing CE-CABG (n = 35,174) versus isolated CABG (n = 79,145) were included. Compared to isolated CABG alone, CE-CABG was significantly associated with increased incidences of 30-days mortality (RR, 1.87; 95% CI, 1.73-2.07; p < 0.01), postoperative myocardial infraction (RR, 1.61; 95% CI, 1.26-2.05; p < 0.01), low output syndrome (RR, 1.54; 95% CI, 1.17-2.02; p < 0.01), and renal dysfunction (RR, 1.56; 95% CI, 1.44-1.69; p < 0.01). However, there was no difference in either rate of cardiac arrhythmia (RR, 1.06; 95% CI, 0.97-1.15; p = 0.20) or 5 years survival (RR, 1.05; 95% CI, 0.95-1.16; p = 0.34) between the CE-CABG group and the control group. Subgroup analysis on CE technique showed that CE-CABG was also associated with 30 days mortality in patients undergoing closed CE (RR, 1.49; 95% CI, 1.09-2.03), whereas this association between CE and 30 days mortality was not observed in patients undergoing open CE (RR, 1.76; 95% CI, 0.58-5.32).Conclusions: Despite poor short-term outcomes, CE-CABG appeared to offer satisfactory long-term survival in patients with diffuse coronary artery disease.
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Affiliation(s)
- Wei Zhang
- Department of Cardiothoracic Surgery, Changzhi People's Hospital, Changzhi, China
| | - Haibo Wu
- Department of Cardiothoracic Surgery, Changzhi People's Hospital, Changzhi, China
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Li H, Gu C, Li B. Endarterectomy may be an effective additional treatment for three diffuse coronary artery disease complicated with diabetes. Perfusion 2024:2676591241237640. [PMID: 38446911 DOI: 10.1177/02676591241237640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE In order to evaluate the clinical efficacy of coronary endarterectomy (CE) and coronary artery bypass grafting (CABG) in patients with diabetes complicated with three diffuse coronary artery stenosis. METHODS A retrospective analysis was conducted on 460 patients with diabetes mellitus and diffuse three-vessel coronary artery disease who underwent CABG in our department from September 2015 to December 2021. The patients were divided into two groups according to whether they underwent CE: the simple CABG group (group A, n = 254) and the CABG combined CE group (group B, n = 206). The perioperative outcomes, recurrent angina pectoris during 1-year follow-up, and the patency rate of the grafted vessel in coronary CT angiography were compared between the two groups. RESULTS There was no significant difference in the 30 days mortality rate between the two groups (2.3% vs 2.4%, p < 0.05). Group A had a shorter operation time [(3.55 ± 0.59) h versus (4.35 ± 0.65) h], less bypass grafts [(2.72 ± 0.83) versus (3.65 ± 0.72) vessels/case], a lower incidence of perioperative myocardial infarction (7.1% vs 12.6%), and a lower number of patent graft vessels at 1-year follow-up [(2.15 ± 0.42) versus (2.88 ± 0.68) vessels/case] compared with group B (all p < 0.05). Group A had a higher incidence of recurrent angina during follow-up (14.49% vs 6.47%) (p < 0.05). Although there was no significant difference in the incidence of MACCE events between the two groups, the probability of revascularization was higher in group A. CONCLUSION Compared with single CABG, combined CE in patients with diabetes mellitus and diffuse three-vessel coronary artery disease can achieve more complete revascularization, reduce the recurrence of angina pectoris and the needing of postoperative revascularization, but the incidence of perioperative myocardial infarction is higher.
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Affiliation(s)
- Haiming Li
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
| | - Bo Li
- Department of Cardiac Surgery, Capital Medical University Beijing Anzhen Hospital, Chaoyang-qu, Beijing, China
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Gao M, Wen W, Gu C, Zhang X, Yu Y, Li H. Coronary plaque burden predicts perioperative cardiovascular events after coronary endarterectomy. Front Cardiovasc Med 2023; 10:1175287. [PMID: 37363096 PMCID: PMC10289079 DOI: 10.3389/fcvm.2023.1175287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background and aims The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative cardiovascular events after off-pump CABG + CE. Methods This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG + CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE, was calculated. The primary endpoint was perioperative myocardial infraction (PMI). Results Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4 ± 1.5 vs. 1.6 ± 0.9, p = .001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p = .005). Patients with plaque length-max ≥1.15 had a > 5-fold increase in PMI after adjusting for confounding factors (odds ratio = 5.89; p = .002). Furthermore, interleukin-6 (Beta = .32: p = .028), CD68 (Beta = .34; p = .045), and osteopontin (Beta = .43; p = .008) were significantly correlated with plaque length-max. Conclusions Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG + CE, which might be associated with systemic and plaque inflammation state.
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Affiliation(s)
- Mingxin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wanwan Wen
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - XiaoLi Zhang
- Department of Nuclear Medicine, Molecular Imaging Lab, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haiyang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Javed A, Siddiqueh M, Anjum Q, Jalal A. Drug-coated balloon angioplasty, intraoperatively through left anterior descending arteriotomy access, a novel hybrid revascularization strategy: a case report. Eur Heart J Case Rep 2023; 7:ytad014. [PMID: 36727128 PMCID: PMC9883707 DOI: 10.1093/ehjcr/ytad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/21/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Patients undergoing coronary artery bypass graft (CABG) sometimes have critical proximal lesion in left anterior descending (LAD) artery or chronic total occlusion followed by either skip lesions or diffuse disease of late mid-to-distal LAD artery. Such lesions require endarterectomy or atheroma bridging via long venous or arterial patch (patch-plasty), for which clinical outcomes are conflicting in studies due to a more thrombogenic milieu created by patch-plasty as well as incomplete endarterectomy. We present a hybrid approach with drug-coated balloon (DCB) angioplasty of mid-to-distal LAD through LAD arteriotomy followed by left internal mammary artery (LIMA) insertion to LAD. Case summary A 35-year-old man who was thrombolyzed for anterior wall myocardial infarction in another city, reported to our hospital four weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch-plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid-to-distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up computerized tomography scan showing patent LIMA and mid-to-distal LAD. Discussion This case shows a novel technique, first in the world, of performing angioplasty during CABG through arteriotomy followed by graft insertion.
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Affiliation(s)
- Asim Javed
- Head of Cardiology Department/Director Cath Lab, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Musfireh Siddiqueh
- Head of Cardiology Department/Director Cath Lab, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Qudsia Anjum
- Head of Cardiology Department/Director Cath Lab, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Anjum Jalal
- Head of Cardiology Department/Director Cath Lab, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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Ellouze M, Bouchard D, Pham M, Noly PE, Perrault LP, Cartier R, Carrier M. Coronary endarterectomy in patients with diffuse coronary artery disease: assessment of graft patency with computed tomography angiography. Can J Surg 2022; 65:E635-E641. [PMID: 36130806 PMCID: PMC9503562 DOI: 10.1503/cjs.011121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/14/2022] Open
Abstract
Background: With a growing population of patients with advanced coronary artery disease (CAD), many of whom have undergone prior percutaneous coronary interventions, coronary endarterectomy (CE) allows for the extension of revascularization in patients with otherwise limited options. Whether adjunctive CE associated with standard surgery, combined with contemporary antiplatelet therapy, improves outcomes remains largely unknown. Methods: We studied 147 consecutive patients who underwent 154 adjunctive CE procedures for advanced CAD between January 2015 and January 2018. We used computed tomography angiography (CTA) in a subgroup of 32 consecutive patients who underwent CE during coronary artery bypass grafting after June 2016 to assess graft and coronary patency. Results: Patients (mean age 67 ± SD 10 yr) underwent CE of the right (102 patients), the left anterior descending (LAD, 22 patients) and the circumflex (17 patients) coronary arteries. Seven patients (5%) experienced a procedural myocardial infarction and there were no perioperative deaths. Among the 32 patients who underwent CTA 3 months after surgery, the mean patency of the endarterectomized coronary arteries and bypass grafts was 90% and 88%, respectively. All 6 arterial grafts on the LAD artery were patent. The mean survival rate and the mean rate of freedom from major adverse cardiovascular events was 95% ± 2% and 95% ± 6%, respectively. The patency rate was 100 % for patients evaluated at 3-year follow up. Conclusion: Coronary endarterectomy offers a surgical option for patients with diffuse CAD who may be unsuitable for coronary bypass alone. Grafts and endarterectomized coronary artery patency remain adequate and explain the excellent patient survival and the freedom rate from major adverse cardiovascular events.
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Affiliation(s)
- Mariam Ellouze
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Denis Bouchard
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Magali Pham
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Pierre Emmanuel Noly
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Louis P Perrault
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Raymond Cartier
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que
| | - Michel Carrier
- Department of Cardiac Surgery (Ellouze, Bouchard, Noly, Perrault, Cartier, Carrier), Montreal Heart Institute and Université de Montréal, Montreal, Que.; Department of Imaging (Pham), Diagnostic Radiology and Nuclear Medicine, Montreal Heart Institute, Montreal, Que.
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Robu M, Marian DR, Lazăr E, Radu R, Boroș C, Sibișan A, Voica C, Broască M, Gheorghiță D, Moldovan H, Iliescu VA. Open Coronary Endarterectomy of Left Anterior Descending Artery—Case Report and Review of Literature. J Cardiovasc Dev Dis 2022; 9:jcdd9030083. [PMID: 35323631 PMCID: PMC8954667 DOI: 10.3390/jcdd9030083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Coronary endarterectomy (CE) emerged as a necessity to achieve complete surgical myocardial revascularization in patients with diffusely diseased coronary arteries and it also serves as aid to coronary bypass grafting (CABG). The safety and postoperative prognosis of this procedure are still matters of debate. There are no clear preoperative indications, a standard technique has not yet been established as gold standard and the postoperative management differs depending on each institution. CE of the left anterior descending artery (LAD) is technically challenging and potentially hazardous with high risk of postoperative myocardial infarction. In this article, we describe the open technique for CE of the LAD with its specific details, which we believe could be the safest and the best reproductible option. To better understand the profile of a patient requiring such a procedure we present the case of a 73-years old male with diffused coronary artery disease (CAD) and a short review of literature.
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Affiliation(s)
- Mircea Robu
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Diana Romina Marian
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Ecaterina Lazăr
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
| | - Răzvan Radu
- Cardiology Department, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Cristian Boroș
- Anesthesia and Intensive Care Department, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Andra Sibișan
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Cristian Voica
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Marian Broască
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Horațiu Moldovan
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.S.); (C.V.); (M.B.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence:
| | - Vlad Anton Iliescu
- Department of Cardiovascular Surgery, Prof. Dr. C.C.Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania; (M.R.); (D.R.M.); (E.L.); (V.A.I.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Kelly JJ, Han JJ, Desai ND, Iyengar A, Acker AM, Grau-Sepulveda M, Zwischenberger BA, Jawitz OK, Hargrove WC, Szeto WY, Williams ML. Coronary Endarterectomy: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2022; 114:667-674. [DOI: 10.1016/j.athoracsur.2022.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
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Tiemuerniyazi X, Yan H, Song Y, Nan Y, Xu F, Feng W. Mid-term outcomes of coronary endarterectomy combined with coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 32:188-195. [PMID: 33221913 PMCID: PMC8906773 DOI: 10.1093/icvts/ivaa252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/23/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the mid-term outcome of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) and explore the potential risk factors for adverse events. METHODS A total of 208 consecutive patients underwent CE between 2008 and 2018 in our centre, of which 198 were included in this retrospective cohort study. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs). Kaplan-Meier analysis was performed to evaluate event-free survival, whereas subgroup analysis and Cox regression were used to explore risk factors for the outcomes. RESULTS The median follow-up time was 34.7 months. CE + CABG was performed mainly on the left anterior descending artery (42.3%) or right coronary artery (42.3%). Both operative mortality and incidence of perioperative myocardial infarction were 1.5%. The overall survival at 3 and 5 years was 98.0% and 95.9%, whereas the MACCE-free survival was 93.7% and 89.4%, respectively. No significant difference in the incidence of MACCE was observed between on-pump and off-pump CE (P = 0.256) or between left anterior descending artery and non-left anterior descending artery endarterectomy (P = 0.540). Advanced age (>65 years) was associated with a higher risk of MACCE both in univariate [hazard ratio (HR) 3.62, 95% confidence interval (CI) 1.37-9.62; P = 0.010] and multivariate analysis (HR 3.59, 95% CI 1.32-9.77; P = 0.013). CONCLUSIONS When performed by experienced surgeons, CE + CABG could be an acceptable approach to achieve complete revascularization of diffusely diseased coronary arteries with satisfactory outcomes, although advanced age might increase the risk of MACCE.
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Affiliation(s)
- Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Yan
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yifeng Nan
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Xu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Corresponding author. Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, 100037 Beijing, China. Tel: +86-10-88396771; fax: +86-10-88322355; e-mail: (W. Feng)
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Kyuchukov D, Zheleva-Kyuchukova I, Nachev G. Antithrombotic regimens in patients after coronary artery bypass grafting and coronary endarterectomy. PHARMACIA 2020. [DOI: 10.3897/pharmacia.67.e52738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Coronary artery bypass grafting (CABG) remains the gold standard in the treatment of complex chronic forms of coronary heart disease (CHD). Coronary endarterectomy (CEAE) is a useful adjunctive technique to CABG in patients with diffuse coronary artery disease. In order to maintain the patency of the coronary arteries and graft conduits, various antithrombotic protocols have been introduced over the years, combining various antiplatelet and anticoagulant drugs, but still there is no consensus.
Aim: The aim of the study is to compare results between two antithrombotic regimens after CEAE. The first one is a combination of acenocoumarol combined with acetylsalicylic acid (ASA), the second regimen is a dual antiplatelet therapy (DAPT) of clopidogrel combined with ASA.
Material and methods: We retrospectively reviewed 56 consecutive patients (60 ± 8.2 years) undergoing isolated CABG in association with CEAE between January 2018 and December 2019. In the postoperative period, patients were divided into two groups according to the antithrombotic regimens described above. Twenty-four were in the ASA and acenocoumarol group (AA) and 32 were in the ASA and clopidogrel group (AC). Patients were followed up to 30 days after the operation and we access the mortality rate, new ECG changes, levels of myocardial fraction of creatinine phosphokinase (CPK-MB), left ventricular systolic function, pericardial or pleural effusions requiring drainage or revision for bleeding.
Results: Operative mortality was 3,6 %. No differences in the antithrombotic efficacy of the two regimens. A significantly higher level of hemorrhagic complications was observed in the ASA + acenocoumarol treatment group.
Conclusion: Dual antiplatelet therapy (DAPT) after CABG and coronary endarterectomy is an effective pharmacological regimen in regard to 30-day postoperative outcomes and is considerably safety in terms of bleeding complications.
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Zhu P, Ye X, Chen A, Liu J, Wang Z, Zhou M, Zhao Q. Does the site of coronary endarterectomy have an impact on the clinical outcomes and graft patency? Interact Cardiovasc Thorac Surg 2020; 29:402-408. [PMID: 31006022 DOI: 10.1093/icvts/ivz099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/13/2019] [Accepted: 03/17/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore whether coronary endarterectomy (CE) sites have obvious impacts on the clinical outcomes and graft patency in off-pump coronary artery bypass (OPCAB). METHODS The patients who underwent OPCAB with CE in our unit between January 2009 and December 2016 were included. The patients and the grafts were grouped according to the CE sites. The primary end points were mid-term main adverse cardiovascular and cerebrovascular events. RESULTS In total, 290 patients who underwent OPCAB with CE were included. CE of the left anterior descending artery (LAD), left circumflex artery and the right coronary artery was performed in 46, 30 and 194 patients, respectively. There were 60, 42 and 217 grafts anastomosed to LAD-CE, left circumflex artery-CE and right coronary artery-CE sites in 290 patients. CE was not performed in the 20 patients requiring multivessel CE. There was no significant difference in perioperative outcomes. The average follow-up time was 51 months (12-103 months). There was no significant difference in mid-term death, main adverse cardiovascular and cerebrovascular events, myocardial infarction (MI), stroke, Canadian Cardiovascular Classification for angina class and 1-year graft patency among the 3 groups. However, the rate of New York Heart Association (NYHA) class III or IV (LAD vs left circumflex artery: 59% vs 25%, P = 0.011; LAD vs right coronary artery: 59% vs 27%, P < 0.001) was higher in the LAD group than in the other groups. These results were consistent with the Kaplan-Meier curves of freedom from the adverse events. CONCLUSIONS CE sites had no obvious impact on mid-term death, main adverse cardiovascular and cerebrovascular events, MI, stroke, Canadian Cardiovascular Classification for angina class and 1-year graft patency in patients who underwent OPCAB with CE. The patients undergoing LAD-CE had higher rates of NYHA class III or IV.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Ye
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anqing Chen
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhe Wang
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Wang C, Chen J, Gu C, Qiao R, Li J. Impact of risk factors and surgical techniques in coronary endarterectomy: a network meta-analysis. Interact Cardiovasc Thorac Surg 2019; 29:355-364. [PMID: 30982903 DOI: 10.1093/icvts/ivz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Summary
The goal of this network meta-analysis was to compare the early mortality rate of patients who underwent coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with different techniques and with isolated CABG. This analysis also evaluated potential risk factors in patients who undergo CE. Eighteen studies were included, covering 21 752 different patients, among whom 3352 underwent CE + CABG with either open or closed techniques and 18 400 underwent isolated CABG. Patients who had CE + CABG had a statistically significant higher mortality rate [odds ratio (OR) 1.76; P < 0.001]. Subgroup analyses showed that, with closed CE, mortality was 52% (OR 1.52, P = 0.001) more likely to occur, whereas with open CE, mortality was 279% (OR 3.79, P < 0.001) more likely to occur, when both were compared with isolated CABG. A network meta-analysis indicated that both the open and closed methods had poorer results than CABG alone and that the open method had a higher risk of mortality than the closed one. For risk factors, diabetes mellitus (DM), hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were significant contributors to inclusion in the CE group, whereas other risk factors showed no significant difference. However, none of these factors indicated significant correlations with the incidence of mortality between the groups. CE + CABG has a significantly higher risk of death than isolated CABG, and open CE is more risky than closed CE, even though most of the individual studies did not show that CE had a higher risk of mortality. Moreover, DM, hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were more common in the patients who had CE + CABG, but these factors may not necessarily increase the mortality risk of patients who have CE.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun Chen
- People’s Hospital of Deyang City, Sichuan, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruiguo Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Off-pump onlay-patch grafting using the left internal mammary artery for a diffusely diseased left anterior descending artery: in-hospital and mid-term outcomes. Coron Artery Dis 2019; 30:354-359. [PMID: 30807293 DOI: 10.1097/mca.0000000000000724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of this study were to evaluate the in-hospital and mid-term outcomes of the off-pump onlay-patch grafting procedure using the left internal mammary artery (LIMA) for a diffusely diseased left anterior descending artery (LAD) and to identify the risk factors for postoperative LIMA graft failure in a single-center retrospective study. PATIENTS AND METHODS A total of 63 patients (52 males, 65.7±9.0 years) undergoing LAD arteriotomy with or without concomitant endarterectomy, followed by reconstruction using LIMA onlay-patch at the time of off-pump coronary artery bypass grafting at our institute from January 2014 to December 2016 were reviewed. The operative mortality, major postoperative morbidity, follow-up all-cause mortality, major adverse cardiac events at follow-up, and postoperative LIMA graft patency were analyzed. The risk factors for postoperative LIMA graft failure on the basis of baseline and surgical characteristics were identified by multivariable logistic regression analysis. RESULTS Eighteen (28.6%) patients underwent concomitant open LAD endarterectomy. The operative mortality rate was 1.6%. Major postoperative morbidity included perioperative myocardial infarction (3.2%), low cardiac output (1.6%), and reoperation for bleeding (1.6%). During the follow-up period of 24.2±9.5 months, all-cause mortality was 1.7% and the incidence of major adverse cardiac events was 6.8%. No repeat revascularization was recorded. In total, 88.1% of LIMA grafts showed FitzGibbon grade A patency determined by noninvasive coronary computed tomography angiography during follow-up. In addition, concomitant LAD endarterectomy and intraoperative LIMA graft flow were found to be independent risk factors for mid-term LIMA graft failure by multivariable logistic regression analysis (odds ratio=2.681, 95% confidence interval: 1.314-9.856, P=0.007 and odds ratio=0.932, 95% confidence interval: 0.791-0.976, P=0.021, respectively). CONCLUSION Revascularization of a diffusely diseased LAD using the off-pump LIMA onlay-patch technique results in encouraging clinical outcomes with favorable angiographic results. Concomitant LAD endarterectomy and intraoperative LIMA graft flow are associated with the risk of postoperative LIMA graft failure.
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Coronary endarterectomy: an old tool for patients currently operated on with coronary artery bypass grafting. Long-term results, risk factor analysis. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 15:219-226. [PMID: 30647744 PMCID: PMC6329878 DOI: 10.5114/kitp.2018.80917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/29/2018] [Indexed: 11/17/2022]
Abstract
Aim Coronary endarterectomy (CE) may provide a useful adjunctive technique to coronary artery bypass grafting (CABG) in patients with diffuse coronary artery disease. Nevertheless, the incidence of complications still remains high, long-term results remain unclear, and no risk factors for late mortality have been completely described yet. Material and methods We retrospectively reviewed 90 consecutive patients (67 ±8.2 years) undergoing isolated CABG in association with CE between 2006 and 2013. Mean follow-up was 75.1 ±36.2 months (median: 84 months) and it was 100% complete (6755/6755 patient-months). Results Operative mortality was 4.4%, the incidence of perioperative myocardial infarction was 11%. Ten-year survival was 83.3 ±4.1%, freedom from cardiac death 92.7 ±2.9%, and freedom from major adverse cardiac and cerebrovascular events 58.2 ±10.2%. Independent predictors of late mortality were age older than 70 years at time of the surgery (p = 0.018) and chronic obstructive pulmonary disease (p = 0.036). Ten-year freedom from cardiac death was better after CE on the left descending coronary artery (LAD) (93.2 ±3.3%) in comparison to CE not on the LAD (74.6 ±10.2%), although this difference did not reach statistical significance (p = 0.102). Conclusions Although the incidence of perioperative myocardial infarction continues to be not negligible, in the presence of diffusely diseased coronary artery vessels CE associated with CABG appears to be a feasible adjunctive surgical tool, conferring satisfactory early and long-term outcomes. Coronary endarterectomy on the LAD confers a high probability of freedom from late cardiac death. Patients older than 70 years and those affected by a primary respiratory disease represent a new challenge on which to focus attention due to the increased risk of late death.
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Vafaey HR, Salehi Omran MT, Abbaspour S, Banihashem N, Faghanzadeh Ganji G. Anti-coagulation therapy following coronary endarterectomy in patient with coronary artery bypass graft. CASPIAN JOURNAL OF INTERNAL MEDICINE 2018; 9:27-31. [PMID: 29387316 PMCID: PMC5771357 DOI: 10.22088/cjim.9.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Since there is a lack of research on postoperative anticoagulation protocol in patients undergoing coronary artery bypass graft (CABG) / coronary endarterectomy (CE), we recommend a new protocol for anticoagulation in these patients. Methods In this double-blind randomized clinical trial study, 52 patients undergoing CABG / CE entered the study and were divided into two groups. In group 1, the patients were given warfarin(international normalized ratio (INR) between 2-3) together with 80 mg aspirin daily for 3 months. In group 2, the patients were given 75 mg plavix daily together with 80 mg aspirin daily for 3 months. We evaluated patients with electrocardiography, echocardiography and checking ceratin phosphokinase MB and troponin I in the several stages. The data were analysed SPSS Version18 software. Results There was no significant difference between pre and post-operative Ejection fraction in patients with plavix (P=0.21) and warfarin (P=0.316) regimen. However, wall mrotion score was significantly better in clopidogrel - aspirin patients in late (3 months) post operation (p<0.001). Conclusions Since warfarin has serious hemorrhagic complications and requires closed monitoring of serum drug activity by serial INR checking, it is recommended that clopidogrel - aspirin can be the preferred alternative anticoagulation therapy in CABG / CE patients.
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Affiliation(s)
- Hamdi Reza Vafaey
- Department of Cardiac Surgery, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | | | - Sadaf Abbaspour
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Nadia Banihashem
- Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran
| | - Ghassem Faghanzadeh Ganji
- Department of Cardiac Surgery, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Sabzi F, Asadmobini A, Rezaei M. Comparing short and long term survival of patients undergoing off pump coronary artery bypass graft with and without coronary endarterectomy. Indian Heart J 2017; 69:646-650. [PMID: 29054191 PMCID: PMC5650583 DOI: 10.1016/j.ihj.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/18/2016] [Accepted: 02/10/2017] [Indexed: 11/18/2022] Open
Abstract
Background and aim There is some controversy about survival of coronary endarterectomy (CE) patients, so the current study aims to compare short and long term survival of patients undergoing off pump coronary artery bypass graft (OPCAB) with and without coronary endarterectomy. Patients and methods we performed a retrospective analysis of data on patients undergoing OPCAB and CE between 2011 and 2012. Preoperative, perioperative and postoperative data collected from data bank. Follow-up information was obtained from telephone contact mean time 37.13 ± 23.82 months after surgery. Early and late outcomes were compared by univariate and Kaplan-Meier analysis. Result OPCAB was performed in 474 patients, which 69 of them had a CE. The mean long term survival was similar between OPCAB (56.28 ± 0.61) and OPCAB + CE (55.54 ± 1.3) groups (p = 0.66). Multiple Cox regression shows that age, gender, BMI, EF and angina were significant predictors of mortality. Patients undergoing CE have a long term intensive care unit (ICU) stay (51.31 ± 5.59 vs 37.23 ± 0.88, P = 0.015) and blood transfusion was higher in CE group (650.62 ± 110 vs. 324.71 ± 22, P = 0.001). Conclusion The current study demonstrates that results of CE are acceptable with respect to short and long -term survival. Patients undergoing CE required long term ICU stay and higher blood transfusion.
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Affiliation(s)
- Feridoun Sabzi
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Atefeh Asadmobini
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mansour Rezaei
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Ghatanatti R, Teli A. Coronary Endarterectomy: Recent Trends. J Clin Diagn Res 2017; 11:PE01-PE04. [PMID: 28969206 DOI: 10.7860/jcdr/2017/27036.10339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/31/2017] [Indexed: 11/24/2022]
Abstract
Coronary Endarterectomy (CE) assures complete revascularization of the myocardium in case of diffusely diseased vessels and prevents residual ischemia. Recently cardiac surgeons are performing increasing number of coronary endarterectomy and it has evolved as an important adjuvant procedure in Coronary Artery Bypass Grafting (CABG). There are controversies regarding the efficiency of CE. CE is criticised for its higher rates of morbidity and mortality. At present the available evidence supports CE in Off Pump Coronary Artery Bypass surgery (OPCAB) and along with valvular procedures. Graft patency is better with open technique. Postoperative anticoagulation regimen though not uniform, the overall outcome remains the same. Therefore, it is important to focus on the current results to accept CE as a routine procedure like CABG.
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Affiliation(s)
- Ravi Ghatanatti
- Consultant Cardiac Surgeon, Department of Cardiothoracic and Vascular Surgery, KLE's Dr Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, India
| | - Anita Teli
- Assistant Professor, Department of Physiology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Wang C, Xin Y, Li N, Li D, Li J, Gu C. Intravascular application of electrocautery in a rabbit model of abdominal aortic endarterectomy. Exp Ther Med 2017; 14:317-323. [PMID: 28672932 PMCID: PMC5488505 DOI: 10.3892/etm.2017.4460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/07/2017] [Indexed: 12/03/2022] Open
Abstract
Effective therapies for preventing perioperative complications such as thrombosis and inflammation after coronary endarterectomy (CE) are lacking. Electrocoagulation electrotomes have been routinely used in surgery for their cutting, clotting, and hemostatic properties. As strong flattening tools, their electrocautery function may prevent mechanical intimal-adventitial injury to arterial circulation and attenuate stenosis. The present study investigated the effects of intravascular application of electrocautery on ameliorating inflammation and thrombosis in a rabbit model of abdominal aortic endarterectomy. New Zealand rabbits were randomly divided into the sham, control (endarterectomy), and study (endarterectomy + electrocautery) groups with 10 in each group. Abdominal aortas were partially blocked and intima was removed. Electrocautery was performed with an electrocoagulation electrotome through the entire blocked vessel lumen. Vascular ultrasound parameters, molecular biological and histological characteristics of the abdominal aorta including vascular diameter, blood flow velocity, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels, and apoptosis rate of vascular endothelial cells (ECs) were evaluated postoperatively by vascular Doppler ultrasound, ELISA, real-time RT-PCR, flow cytometry, and immunofluorescence at various time points. Compared with the endarterectomy + electrocautery group, the isolated endarterectomy group had significantly increased levels and gene expression of TNF-α and IL-6 (P<0.05), and rates of apoptosis of vascular ECs (P<0.05), with gradual vascular stenosis and decreased blood flow velocity. In conclusion, intravascular application of electrocautery has favorable short-term effects on the abdominal aorta and can reduce inflammation in a rabbit model of abdominal aorta endarterectomy. Long-term anti-inflammatory and anti-thrombotic effects on arterial remodeling and the clinical value of electrocautery in CE remain to be determined.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P.R. China
| | - Yi Xin
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P.R. China
| | - Na Li
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P.R. China
| | - Diankun Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China.,Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, P.R. China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Nishigawa K, Fukui T, Yamazaki M, Takanashi S. Ten-Year Experience of Coronary Endarterectomy for the Diffusely Diseased Left Anterior Descending Artery. Ann Thorac Surg 2017; 103:710-716. [DOI: 10.1016/j.athoracsur.2016.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/07/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Aborted anterior myocardial infarction vs. takotsubo syndrome: The case of a patient with a stenoticwrap-around left anterior descending coronary artery. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.38872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wang J, Gu C, Yu W, Gao M, Yu Y. Short- and Long-Term Patient Outcomes From Combined Coronary Endarterectomy and Coronary Artery Bypass Grafting: A Meta-Analysis of 63,730 Patients (PRISMA). Medicine (Baltimore) 2015; 94:e1781. [PMID: 26469920 PMCID: PMC4616783 DOI: 10.1097/md.0000000000001781] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This meta-analysis aimed to compare the short- and long-term outcomes in patients undergoing combined coronary endarterectomy and coronary artery bypass grafting (CE + CABG) versus isolated CABG, and particularly to examine subgroup patients with high-risk profile and patients with diffuse disease in the left anterior descending artery (LAD).Studies published between January 1, 1970 and May 31, 2015 were searched in the literature databases, including Ovid Medline, Embase, PubMed, and ISI Web of Science.A total of 30 eligible studies including 63,730 patients were analyzed.Five authors extracted data from the included studies independently.Meta-analysis on the total patients revealed that CE + CABG was associated with significantly increased 30-day postoperative all-cause mortality compared with isolated CABG (OR = 1.86, 95% CI: 1.66-2.08, z = 10.99, P < 0.0001). Subgroup analysis on patients with high-risk profile and patients with diffuse disease in the LAD showed that 30-day mortality after CE + CABG was 2.6 folds (OR = 2.60, 95% CI: 1.39-4.86, z = 2.99, P = 0.003) and 3.93 folds (OR = 3.93, 95% CI: 1.40-11.0, z = 2.60, P = 0.009) of that after isolated CABG in the respective subgroup. In contrast, the mortality was comparable in CE + off-pump CABG and CE + on-pump CABG groups (OR = 0.53, 95% CI: 0.18-1.55, z = 1.16, P = 0.248). In addition, the incidences of perioperative myocardial infarction (MI) and 30-day postoperative complications, including low output syndrome (LOS), MI, ventricular tachycardia (VT), and renal dysfunction after CE + CABG were significantly higher than those after isolated CABG (all P < 0.05). In high-risk patient subgroup, CE + CABG significantly increased the incidences of postoperative LOS, MI, and renal function compared with isolated CABG (all P < 0.05). The incidence of perioperative myocardial after CE + CABG was 2.86 and 2.92 times of that after isolated CABG in high-risk patients and patients with diffuse disease in LAD, respectively. Analysis on the recent reports (published later than 2000) showed consistent results as the analysis including all the eligible reports. Long-term survival was comparable in CE + CABG and isolated CABG groups (hazardous ratio = 1.16, 95% CI: 0.32-4.22, z = 0.23, P = 0.819).CE + CABG appears to be associated with poor short-term outcomes, particularly in high-risk patients and patients with diffuse disease in the LAD.
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Affiliation(s)
- Jiayang Wang
- From the Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
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Chi LQ, Zhang JQ, Kong QY, Xiao W, Liang L, Chen XL. Early results of coronary endarterectomy combined with coronary artery bypass grafting in patients with diffused coronary artery disease. Chin Med J (Engl) 2015; 128:1460-4. [PMID: 26021501 PMCID: PMC4733784 DOI: 10.4103/0366-6999.157652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221) of the cohort. All these patients were divided into two groups: CE + CABG group (Group A) and CABG alone group (Group B). All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively. Results: Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38), which was more often than that in Group B (3/183). At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50). There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions: Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.
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Affiliation(s)
- Li-Qun Chi
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Wang J, Gu C, Gao M, Yu W, Yu Y. Adjunct coronary endarterectomy increases cerebrovascular accident after coronary artery bypass grafting: a meta-analysis of 17,600 patients. Int J Cardiol 2015; 182:79-81. [PMID: 25576727 DOI: 10.1016/j.ijcard.2014.12.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Jiayang Wang
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chengxiong Gu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing An Zhen Hospital, Capital Medical University, Beijing 100029, China.
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Nemati MH, Astaneh B, Khosropanah S. Outcome and graft patency in coronary artery bypass grafting with coronary endarterectomy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:13-24. [PMID: 25705593 PMCID: PMC4333844 DOI: 10.5090/kjtcs.2015.48.1.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/26/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66±3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. Results Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88±0.39 vs. 2.70±0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. Conclusion The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.
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Affiliation(s)
| | - Behrooz Astaneh
- Medical Journalism Department, Paramedical School, Shiraz University of Medical Sciences
| | - Shahdad Khosropanah
- Cardiology Department, Medical School, Shiraz University of Medical Sciences
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Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg 2014; 19:462-73. [DOI: 10.1093/icvts/ivu157] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coronary endarterectomy for the diffusely diseased coronary artery. Gen Thorac Cardiovasc Surg 2014; 62:461-7. [DOI: 10.1007/s11748-014-0414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Indexed: 10/25/2022]
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Coronary endarterectomy: new flavors from old recipes. J Cardiol 2014; 63:397-401. [PMID: 24674746 DOI: 10.1016/j.jjcc.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/30/2014] [Accepted: 02/03/2014] [Indexed: 11/22/2022]
Abstract
Coronary endarterectomy is an old surgical procedure against coronary artery disease first described by Baily et al. in 1957. Despite its first adverse results, several current publications have shown that coronary endarterectomy with on-pump or off-pump coronary artery bypass grafting can be safely performed with acceptable mortality, morbidity, and angiographic patency rates. Coronary endarterectomy can assure complete revascularization supplying the myocardium with satisfactory blood flow in cases of a diffusely diseased left anterior descending artery or diffuse calcification, thus preventing residual ischemia. Hence, it is important to evaluate current results, rethink this old recipe, and redefine its indications.
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Alreshidan M, Albabtain M, Obied H, Alassal M, Albaradai A, Alghofaili F. Does Coronary Endarterectomy Increase Early Mortality and Morbidity Compared with Coronary Artery Bypass Surgery Alone-Single Centre Experience. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.55033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mert M, Cetin G, Yildiz CE, Ugurlucan M, Caglar IM, Ozkara A, Akcevin A, Bakay C. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease. J Cardiothorac Surg 2010; 5:87. [PMID: 20958964 PMCID: PMC2984402 DOI: 10.1186/1749-8090-5-87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 10/19/2010] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. PATIENTS AND METHODS In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. RESULTS Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). CONCLUSION We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis.
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Affiliation(s)
- Murat Mert
- Department of Cardiovascular Surgery, Instiute of Cardiology, Istanbul University, Istanbul, Turkey.
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Schmitto JD, Kolat P, Ortmann P, Popov AF, Coskun KO, Friedrich M, Sossalla S, Toischer K, Mokashi SA, Tirilomis T, Baryalei MM, Schoendube FA. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease. J Cardiothorac Surg 2009; 4:52. [PMID: 19772645 PMCID: PMC2756249 DOI: 10.1186/1749-8090-4-52] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 09/22/2009] [Indexed: 12/01/2022] Open
Abstract
Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE), it is still used as an adjunct to coronary artery bypass grafting (CABG). This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA), angina pectoris (CCS) and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient). In 98% left internal thoracic artery (LITA) was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA) (n = 55), on left anterior descending artery (LAD) (n = 52) and circumflex artery (RCX) (n = 7). Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%). Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5). During follow-up (24.5 ± 13.4 months), which is 96% complete (4 patients were lost caused by unknown address) 8 patients died (cardiac failure: 3; stroke: 1; cancer: 1; unknown reasons: 3). NYHA-classification significantly improved after CABG with CE from 2.2 ± 0.9 preoperative to 1.7 ± 0.9 postoperative. CCS also changed from 2.4 ± 1.0 to 1.5 ± 0.8 Conclusion Early results of coronary endarterectomy are acceptable with respect to mortality, NYHA & CCS. This technique offers a valuable surgical option for patients with endstage coronary artery disease in whom complete revascularization otherwise can not be obtained. Careful patient selection will be necessary to assure the long-term benefit of this procedure.
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Affiliation(s)
- Jan D Schmitto
- Department of Thoracic-, Cardiac- and Vascular Surgery, Georg August University of Goettingen, Germany.
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Abid AR, Farogh A, Naqshband MS, Akhtar RP, Khan JS. Hospital Outcome of Coronary Artery Bypass Grafting and Coronary Endarterectomy. Asian Cardiovasc Thorac Ann 2009; 17:59-63. [DOI: 10.1177/0218492309102609] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To compare hospital mortality and postoperative complications in patients with severe coronary artery disease undergoing coronary artery bypass grafting with or without coronary endarterectomy, 100 consecutive patients were divided into 2 groups of 50 patients each. Group 1 had coronary endarterectomy, and group 2 had no coronary endarterectomy. There were 87 men and 13 women, with a mean age of 54.79 ± 7.8 years; 48% had stable angina. The right coronary artery was endarterectomized in 22 patients, the left anterior descending artery in 21, and the left circumflex in 7. There were no significant differences in outcomes. There was 1 hospital death in each group. Perioperative myocardial infarction occurred in 2 patients in group 1 and 1 in group 2. Endarterectomy is a suitable option to achieve complete revascularization in patients with refractory angina and severe diffuse disease.
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Affiliation(s)
| | - Ajwad Farogh
- Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Mumraiz S Naqshband
- Department of Research and CME, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Raja P Akhtar
- Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Jawad S Khan
- Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, Pakistan
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Abstract
Coronary artery bypass grafting has had a significant impact on the treatment of angina, and has been the 'gold standard' since 1969. Its use and efficacy has been increased by revascularization in cardiac arrest and the use of the internal mammary artery. In parallel, catheter techniques have evolved by means of balloon dilatation and additional stenting. This has effected the referral to surgery despite the development of new arterialization techniques and minimally invasive surgery. As competing techniques, an acceptable equilibrium between surgery and stenting will be found within the next years.
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Affiliation(s)
- Olaf Stanger
- University Hopsital for Cardiac Surgery Salzburg, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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Abstract
PURPOSE OF REVIEW The increasing incidence of diffuse coronary artery disease in the current era challenges cardiac surgeons in accomplishing their goal of complete revascularisation. Although coronary endarterectomy is used with encouraging results in most institutions, there remains some controversy in its indications, technique, and results. The purpose of this review is to highlight the important evolutions of technique in the recent past. RECENT FINDINGS Despite the increased risk factors and comorbidities in patients presenting with diffuse coronary artery disease requiring coronary endarterectomy, the results of coronary endarterectomy are improving inline with the improvements in the results of conventional coronary artery bypass grafting surgery. The improving results of coronary endarterectomy in the left anterior descending artery are further clarified. The intra- and postoperative use of prostacyclin has been shown to be effective in reducing mortality and perioperative myocardial infarction. The technique of open coronary endarterectomy with on-lay patch bypass grafting has been shown to be safe and effective in reducing mortality and improving patency as compared with the closed (traction) method of coronary endarterectomy. The use of coronary endarterectomy was also found to be effective in the treatment of in-stent restenosis in the setting of diffuse coronary artery disease. The results of off-pump coronary endarterectomy are encouraging and comparable with the conventional coronary endarterectomy using cardiopulmonary bypass. SUMMARY With the increasing incidence of diffuse coronary artery disease and improving results of coronary endarterectomy, it is vital for cardiac surgeons to have coronary endarterectomy in their armamentarium to achieve complete coronary revascularisation.
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