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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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Balaj I, Jakob H, Haddad A, Mourad F, Haneya A, Ali E, Ryadi N, Thielmann M, Ruhparwar A, Shehada SE. Role of Antiplatelet Therapy in Patients with Severe Coronary Artery Disease Undergoing Coronary Artery Endarterectomy within Coronary Artery Bypass Surgery. J Cardiovasc Dev Dis 2023; 10:jcdd10030112. [PMID: 36975876 PMCID: PMC10051999 DOI: 10.3390/jcdd10030112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
Background—Coronary endarterectomy (CEA) has been introduced to allow revascularization in end-stage coronary artery disease (CAD). After CEA, the injured remnants of the vessel’s media could result in fast neo intimal tissue ingrowth, which require an anti-proliferation agent (antiplatelet therapy (APT). We aimed to review outcomes of patients undergoing CEA within bypass surgery who received either single-APT (SAPT) or dual-APT (DAPT). Methods—We retrospectively evaluated 353 consecutive patients undergoing CEA within isolated coronary artery bypass grafting (CABG) in the period 01/2000–07/2019. After surgery, patients received either SAPT (n = 153), or DAPT (n = 200) for six months then lifelong SAPT. Endpoints included early, late survival, and freedom from major-adverse-cardiac and cerebrovascular events (MACCE), which were defined as incidence of stroke, myocardial infarction, need for coronary intervention (PCI or CABG) or death for any cause. Results—Patients’ mean age was 67 ± 9.3 years; they were predominantly male 88.1%. Both DAPT- and SAPT-groups had the same extent of CAD (mean SYNTAX-Score-II: 34.1 ± 11.6 vs. 34.4 ± 17.2, p = 0.91). Postoperatively, no difference between DAPT- and SAPT-groups was reported in the incidence of low-cardiac-output syndrome (5% vs. 9.8%, p = 0.16), revision for bleeding (5% vs. 6.5% p = 0.64), 30-day mortality (4.5% vs. 5.2%, p = 0.8) or MACCE (7.5% vs. 11.8%, p = 0.19). Imaging follow-up reported significantly higher CEA and total grafts patency (90% vs. 81.5% and 95% vs. 81%, p = 0.017) in DAPT patients. Late outcomes within 97.4 ± 67.4 months show lower incidence of overall mortality (19 vs. 51%, p < 0.001) and MACCE (24.5 vs. 58.2%, p < 0.001) in the DAPT patients when compared with SAPT patients. Conclusions—Coronary endarterectomy allows revascularization in end-stage CAD when the myocardium is still viable. The use of dual APT after CEA for at least six months seems to improve mid-to-long-term patency rates and survival, and reduced the incidence of major adverse cardiac and cerebrovascular events.
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Affiliation(s)
- Ilir Balaj
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Ali Haddad
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Fanar Mourad
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, 24106 Kiel, Germany
| | - Ebrahim Ali
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Noura Ryadi
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
- Correspondence:
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Current status of adult cardiac surgery-Part 1. Curr Probl Surg 2022; 59:101246. [PMID: 36496252 DOI: 10.1016/j.cpsurg.2022.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Outcomes of Patients Undergoing Closed Traction CoronaryEndarterectomy: A Long-Term Single Center Study. J Clin Med 2022; 11:jcm11237026. [PMID: 36498601 PMCID: PMC9735959 DOI: 10.3390/jcm11237026] [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: 09/24/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background-Coronary endarterectomy (CEA) is an option for treating severely diffused coronary artery diseases; however, many surgeons avoid performing it due to its complexity and reported controversial results. Therefore, we aimed to review the results of patients undergoing CEA within coronary artery bypass grafting (CABG). Methods-This is a retrospective observational study evaluating the results of patients undergoing CEA within CABG surgery between March 2003 and February 2018. Follow-up via active personal and/or telephone interviews was performed to evaluate long-term clinical outcomes. The study endpoints included early postoperative incidence of myocardial infarction or cardiac mortality, long-term survival, and freedom from major adverse cardiac and cerebrovascular events (MACCE). Results-A total of 326 patients were included in this study for evaluation. The patients' mean age was 67 years; 88% were male, and most presented with three-vessel disease, reporting a mean SYNTAX score of 33.1 ± 12. Approximately 5.5% (n = 18) of the patients had undergone previous CABG surgery. A total of 394 CEAs within a mean of 4.3 ± 1.1 grafts per patient were performed. The indication for CEA was either totally (n = 111, 28.2%) or sub-totally (n = 283, 71.8%) occluded coronary arteries. Early results included perioperative myocardial infarction in eight (2.4%), stroke in eight (2.4%), and in-hospital mortality in thirteen (4.0%) patients. Long-term clinical follow-up reported mortality in 27.6% and overall incidence of MACCE in 41.4% of the patients at the ten-year follow-up. Conclusions-Patients with severe and diffuse CAD are difficult candidates for surgical revascularization. CEA offers an option to allow complete revascularization, even in the case of chronic occlusion, when the myocardium is still viable. The closed traction CEA technique presented here is our preferred method; it achieves satisfactory short- and long-term results.
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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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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Nishigawa K, Fukui T, Takaki J, Takanashi S. Coronary endarterectomy for diffusely diseased coronary artery: An ace in the hole in coronary artery surgery. JTCVS Tech 2021; 10:133-137. [PMID: 34977715 PMCID: PMC8689673 DOI: 10.1016/j.xjtc.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/05/2022] Open
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Fayad ESA, Amr MA. Short-term outcomes of reconstruction of extensively diseased left anterior descending artery with or without endarterectomy: a propensity score analysis. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Surgical management of extensively diseased left anterior descending artery (LAD) is challenging. Reconstruction of the LAD with endarterectomy may lead to intimal disruption and affect the outcomes of surgery. We aimed to compare hospital outcomes of surgical reconstruction of extensively diseased LAD with and without endarterectomy.
Results
This retrospective multicenter study included 275 patients who had reconstruction of extensively diseased LAD from 2015 to 2019. We divided patients into two groups: group 1 (n = 138) included patients who had plaque exclusion and patching, and group 2 (n = 137) included patients who had endarterectomy and patching. All patients had primary isolated on-pump coronary artery bypass grafting with the left internal mammary artery (LIMA) grafting to LAD. On-lay LIMA patch was used in 118 patients in group 1 and 132 patients in group 2. A saphenous vein patch was used in 20 patients in group 1 and 5 patients in group 2. Propensity score matching identified 100 matched pairs. The age in group 1 was 56.1 ± 7.8 years versus 55.2 ± 7.1 in group 2 (P = 0.34). There were 119 (86.2%) males in group 1 and 113 (82.5%) in group 2 (P = 0.39). After matching, there was no difference in preoperative and operative data. In the matched groups, low cardiac output occurred in 6 (6%) patients in group 1 and 4 (4%) patients in group 2 (P = 0.73). There was no difference in mechanical ventilation time between groups (9 (25th- 75th percentiles: 7.5–14) hours in group 1 vs. 9 (7–14) hours in groups 2; P = 0.93). Length of hospital stay was 7 (6–9) days in group 1 and 7 (6–10) days in group 2 (P = 0.57). Mortality occurred in one patient in group 1. We did not report early graft occlusion cases in group 1, and one patient had a myocardial infarction in group 2.
Conclusion
The outcomes after reconstructing extensively diseased LAD with endarterectomy or plaque exclusion and patching are satisfactory and comparable in both approaches.
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Shehada SE, Mourad F, Balaj I, El Gabry M, Wendt D, Thielmann M, Schlosser T, Jakob H. Long-Term Outcomes of Coronary Endarterectomy in Patients With Complete Imaging Follow-Up. Semin Thorac Cardiovasc Surg 2020; 32:730-737. [DOI: 10.1053/j.semtcvs.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/16/2019] [Indexed: 11/11/2022]
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10
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Ramasubrahmanyam G, Panchanatheeswaran K, Varma Kalangi TK, Nagasaina Rao G. Surgical management of diffusely diseased coronary arteries. Indian J Thorac Cardiovasc Surg 2019; 35:453-460. [PMID: 33061030 DOI: 10.1007/s12055-018-0776-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To analyze the outcomes of long segment coronary anastomoses in patients with diffusely diseased coronary arteries and compare them with medically managed patients. Methods We retrospectively studied patients with diffusely diseased coronary arteries who underwent complete revascularization with long segment coronary reconstruction (> 2 cm in length) from February 2015 to November 2016. During the same time, patients who opted medical management for diffuse coronary artery disease were also studied. Results Forty-one patients underwent long segment coronary anastomoses for diffuse coronary artery disease with either left internal thoracic artery (LITA) or saphenous vein conduits. In 15 (36.58%) patients, the anastomosis length was more than 4 cm. In 41 patients, left anterior descending (LAD) artery had long segment anastomosis and in four patients, posterior descending artery (PDA) had long segment anastomosis. Twenty-one patients were operated off-pump and the rest were operated on cardiopulmonary bypass. The post-operative recovery of all the patients was uneventful. There were no procedural complications. There was one mortality due to cerebrovascular accident (2.43%). During the study period, 50 patients with diffuse coronary artery disease were under medical management. In the medically managed group, there were seven death during the follow-up, with mortality rate of 14%. Conclusion Patients with diffuse disease coronary diseases, who are surgically managed, have a better outcome when compared to the medically managed patients with acceptable morbidity and mortality.
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Affiliation(s)
- Gutti Ramasubrahmanyam
- Department of Cardiothoracic Surgery, Care Hospitals, Banjara Hills, Hyderabad, 500034 India
| | | | - Tej Kumar Varma Kalangi
- Department of Cardiothoracic Surgery, Care Hospitals, Banjara Hills, Hyderabad, 500034 India
| | - Goli Nagasaina Rao
- Department of Cardiothoracic Surgery, Care Hospitals, Banjara Hills, Hyderabad, 500034 India
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Monteiro JP, Rijo D, Pereira R, Ponce P, Vouga L. Extensive coronary endarterectomy in the left anterior descending artery. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Borrell-Pages M. Lessons learned by atherosclerotic plaques at necropsy. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:73-74. [PMID: 30904053 DOI: 10.1016/j.arteri.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maria Borrell-Pages
- Programa ICCC, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, CIBER-CV, Barcelona, Spain.
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Abdullah HM, Khan A, Khan Afridi M, Jan A, Khan UI, Ullah W, Ahmad A, Omar M, Khan I, Khan A. A Retrospective Cohort Study on Coronary Endarterectomy Outcomes in Coronary Artery Bypass Graft Patients. Cureus 2019; 11:e4279. [PMID: 31157140 PMCID: PMC6529046 DOI: 10.7759/cureus.4279] [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] [Indexed: 11/28/2022] Open
Abstract
Introduction: The aim of this study is to determine the outcomes following coronary endarterectomy (CE) in patients who underwent coronary artery bypass grafting (CABG) for revascularization in our hospital. Methods: We retrospectively reviewed patients who underwent CABG over a six-month period, from November 1, 2016 to May 31, 2017 and examined their outcomes in regards to CE. Results: A total of (n=361) CABG procedures were performed in our study period, though complete records were available for only (n=254) patients. Amongst these, (n=37) patients (14.5%) required CE. Ages ranged from 43 to 75 years for these patients, (n=7) were females and (n=30) males. Comorbidities included hypertension in (n=19) patients, diabetes in (n=12) patients and hepatitis B in (n=11) patients. The right coronary artery (RCA) was the most common artery endarterectomized (n= 15), followed by the left anterior descending (LAD) (n= 10), obtuse marginal (n= 6 patients), diagonals (n=5) and ramus (n=2). Two vessels were endarterectomized in (n=4) patients. A total of (n=9) patients had two-vessel CABG, (n=16) had three-vessel CABG and (n=8) had four-vessel CABG. The left internal mammary artery (LIMA) was used in (n=25) patients. Two patients required intra-aortic balloon pump post-operatively. All the patients had received inotropic support postoperatively in the intensive care unit (ICU). There were no reports of postoperative mortality. One patient remained in the ICU for four days postoperatively, the rest of the patients were stepped down to the ward in less than four days. Conclusions: CE is a safe and viable option as an adjunct to CABG in long segment totally occluded vessels needing revascularization and reconstruction.
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Affiliation(s)
| | - Adnan Khan
- Cardiology, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Azam Jan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Uzma I Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Asrar Ahmad
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
| | - Muhammad Omar
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Ishaq Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Arsalan Khan
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
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Pérez Sorí Y, Herrera Moya VA, Puig Reyes I, Moreno-Martínez FL, Bermúdez Alemán R, Rodríguez Millares T, Fleites Medina A. Histology of atherosclerotic plaque from coronary arteries of deceased patients after coronary artery bypass graft surgery. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 31:63-72. [PMID: 30262443 DOI: 10.1016/j.arteri.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Ischaemic heart disease is an important health problem. The characteristics of atherosclerotic plaques determine patient outcome. The aim of this study was to determine the histological grade of coronary atherosclerotic lesions in deceased patients after coronary artery bypass graft surgery, and to identify the complications of the severe plaques. METHOD A descriptive, cross-sectional, prospective study was carried out on 21 anatomical pieces of deceased patients over a period of 3 years. The epicardial coronary arteries were sectioned transversally every 1cm, and the odd numbered fragments and the regions of the anastomosis with the grafts were selected. They were embedded in paraffin, stained with haematoxylin-eosin, and the histological slides were studied using an Olympus BHM microscope. RESULTS An age over 50 years (85.7%), male gender (81.0%), and smoking (66.7%) predominated. Peri-operative infarction (38.1%) and cardiogenic shock (33.3%) were the main direct causes of death. The majority of the grafts were of venous origin (64.6%), and 149 lesions were detected, of which 116 (77.8%) were severe plaques, and 47.4% of them were located in the left anterior descending artery. The large majority (81.9%) of the lesions were located in the arterial segments proximal to the graft. A total of 255 histological complications were detected in the severe plaques, with 75.0% showing calcification. Hypertensive patients had more plaques with more complications, but no statistically significant association was found between these variables. CONCLUSIONS Severe plaques predominated, mostly located in the proximal segments of the coronary arteries, and the left anterior descending was the most affected artery. Calcification was the most observed complication in the severe plaques.
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Affiliation(s)
- Yanet Pérez Sorí
- Universidad de Ciencias Médicas de Villa Clara, Villa Clara, Cuba
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15
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Minato N, Okada T, Kanemoto S, Zempo N. Segmental clamp and distal perfusion technique for reducing myocardial ischemia during coronary onlay grafting on a beating heart. Surg Today 2018; 48:566-570. [PMID: 29318373 DOI: 10.1007/s00595-017-1623-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
Abstract
We present a segmental clamp with distal perfusion technique to reduce myocardial ischemia during onlay grafting, on a beating heart. After a proximal coronary arteriotomy for 2-3 cm, the distal artery is perfused through a cannula, with femoral arterial blood (distal perfusion with external shunt). During proximal and distal coronary snare clamping with distal perfusion, onlay anastomosis is performed, from the heel toward the point of cannula insertion. We then move the proximal clamp to the onlay area and open the graft, to get early proximal coronary reperfusion. The arteriotomy is extended, and this procedure is repeated to achieve complete beating heart onlay anastomosis. We safely performed this procedure on the beating heart off-pump or on-pump in 95 patients with no perioperative myocardial infarction, no intraoperative hemodynamic deterioration, no 30-day mortality. This technique reduces regional myocardial ischemic and secures the safety for onlay grafting on the beating heart.
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Affiliation(s)
- Naoki Minato
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan.
| | - Takayuki Okada
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Shinya Kanemoto
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
| | - Nobuya Zempo
- Department of Cardiovascular Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata City, Osaka, 573-1010, Japan
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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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17
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Hybrid metal/scaffold-jacket versus full-metal jackets in left anterior descending coronary artery diffuse disease: Differences in radiation exposure and fluoroscopic/procedural times. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:592-595. [PMID: 28546035 DOI: 10.1016/j.carrev.2017.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/12/2017] [Accepted: 05/16/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE Bioabsorbable vascular scaffolds (BVS) are made from a radiolucent material. Their multiple implantations on a single long diffused segment requires a specific technique with imaging magnification, which could cause an increase in dose delivered during percutaneous coronary intervention (PCI) procedure. We aimed to identify differences in radiation dose, fluoroscopy and procedural times in Hybrid DES+ multiple BVS (Absorb, Abbott Inc., USA) implantation (hybrid metal/scaffold jacket) versus multiple III generation Drug-eluting stents (DES) (full-metal jacket) in patients with long and diffuse coronary artery disease of the left anterior descending (LAD) coronary artery. METHODS/MATERIALS Patients with long and diffuse LAD disease were enrolled in a registry from 1st February 2015 to 1st February 2017. Patients treated with hybrid DES/BVS (at least three) jacket (n=72 procedure) were compared with a 2:1 matched cohort of exclusive multiple overlapped DES (full-metal jacket) patients in the same period (n=114 procedures). RESULTS Patients had similar baseline characteristics due to matching. Radiation exposure (6035.7±2846.8 vs 4251.1±1787.3cGy∗cm2, p<0.0001, Δ=1784.5±1055.6), fluoroscopy time (16.2±4.5 vs 9.1±2.4, p<0.0001) and procedure time (64.2±18.5 vs 5 8.7±13.5, p=0.02) were higher in patients treated using hybrid metal/scaffold jacket compared that regular full-metal jacket. CONCLUSION The use of hybrid metal/scaffold jacket for the treatment of long and diffuse disease of LAD is associated with a higher fluoroscopy time and radiation exposure compared to full-metal jacket, quantifiable in approximately 35%.
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18
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Katselis C, Samanidis G, Papasotiriou A, Karatasakis G, Nenekidis I, Demerouti E, Antoniou T, Perreas K. Outcomes after a left anterior descending artery endarterectomy in advanced coronary artery disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:332-337. [PMID: 28283374 DOI: 10.1016/j.carrev.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/05/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Coronary endarterectomy albeit infrequently utilized remains a pivotal treatment modality for advanced atherosclerotic heart disease. Benefits of coronary endarterectomy are explored in terms of better mid-term survival, freedom of major adverse cardiac and cerebrovascular events and improved left ventricular ejection fraction. METHODS 50 patients with coronary artery disease including extensive diffuse LAD disease underwent a left anterior descending artery endarterectomy with coronary by-pass grafting and left internal mammary artery as conduit between 2006 and 2014. Prospective evaluation was performed on an outpatient basis with physical examination, echo recordings of ejection fraction and LAD flow reserve for 24 up to 60months. RESULTS Study group was constituted by a male to female ratio 4:1 and mean age 62.4years old. Pre-operative characteristics included patients with age<60years old and gensini score>60 in 42.1% while patients with age>60years old had gensini score (21-60) in 63.4%. Furthermore, males were affected more severely by atherosclerosis than females. Postoperative anterior wall contractility of left ventricle was improved (56% pre-op vs. 66% post-op) and hypokinesis reduced (34% pre-op vs. 24% post-op). No deaths were recorded for a mean follow-up of 48months. Also, MACCE were recorded in 8% patients. Post-operative LAD flow reserve was normal in 66% and reduced in 33% of cases. Finally, gensini score preoperatively affects mid-term flow reserve postoperatively (p<0.05). CONCLUSION Coronary endarterectomy presents a viable modality that preserves myocardial function and restores LAD flow in patients with diffuse atherosclerotic LAD. Also postoperative adverse effects were minimal while mid-term flow reserve was affected by preoperative factors.
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Affiliation(s)
- Charalampos Katselis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - George Samanidis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | - George Karatasakis
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ioannis Nenekidis
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Eftichia Demerouti
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Theofani Antoniou
- Department of Anesthesiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Konstantinos Perreas
- 1st Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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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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Rigatelli G, Avvocata FD, Ronco F, Giordan M, Roncon L, Caprioglio F, Grassi G, Faggian G, Cardaioli P. Edge-to-Edge Technique to Minimize Ovelapping of Multiple Bioresorbable Scaffolds Plus Drug Eluting Stents in Revascularization of Long Diffuse Left Anterior Descending Coronary Artery Disease. J Interv Cardiol 2016; 29:275-84. [PMID: 27245123 DOI: 10.1111/joic.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Implantation of Drug Eluting Stents (DES) plus bioresorbable scaffolds (BVS) in very long diffuse left anterior descending coronary artery (LAD) disease may be problematic because of multiple devices overlapping. We sought to assess the short and mid-tern outcomes of combined implantation of DES and BVS using a novel "edge-to-edge" technique in patients with diffuse LAD disease. METHODS Patients with long diffuse LAD disease were enrolled in a prospective registry from 1st August 2014 to 1st August 2015 and treated with IVUS-aided percutaneous coronary intervention using a DES plus a single or multiple BVS using a novel "edge-to-edge" technique. Clinical follow up and invasive follow up driven by clinical justification was performed. RESULTS Twenty-three patients (5 females, mean age 59.1± 9.1 years) were enrolled. Mean length of LAD disease was 73.1 ± 20.6 mm. Mean number of DES and BVS implanted was 1.2 ± 0.4 and 1.7 ± 1.3, respectively. At a mean follow-up of 11.3 ± 3.8 months, no stent thrombosis or MACE were observed. Angiographic and IVUS follow-up at a mean of 6.6 ± 0.7 months showed no significant angiographic restenosis and no appreciable stent gaps. CONCLUSIONS In revascularization of long diffuse disease of the LAD, the edge-to-edge implantation technique appears to be feasible resulting in no restenosis or thrombosis on the short-term follow-up. (J Interven Cardiol 2016;29:275-284).
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Fabio Dell' Avvocata
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Federico Ronco
- Emodinamica Aziendale, ULS 12 Veneziana, Mestre-Venezia, Italy
| | - Massimo Giordan
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Loris Roncon
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | | | - Giuseppe Grassi
- Emodinamica Aziendale, ULS 12 Veneziana, Mestre-Venezia, Italy
| | - Giuseppe Faggian
- Cardiac Surgery Institute, Verona University School of Medicine, Verona, Italy
| | - Paolo Cardaioli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
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Stavrou A, Gkiousias V, Kyprianou K, Dimitrakaki IA, Challoumas D, Dimitrakakis G. Coronary endarterectomy: The current state of knowledge. Atherosclerosis 2016; 249:88-98. [DOI: 10.1016/j.atherosclerosis.2016.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
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Heo W, Min HK, Kang DK, Lee SK, Jun HJ, Hwang YH. Long Segmental Reconstruction of Diffusely Diseased Left Anterior Descending Coronary Artery Using Left Internal Thoracic Artery with Extensive Endarterectomy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:285-8. [PMID: 26290842 PMCID: PMC4541061 DOI: 10.5090/kjtcs.2015.48.4.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022]
Abstract
In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.
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Affiliation(s)
- Woon Heo
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
| | - Ho-Ki Min
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
| | - Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
| | - Sung Kwang Lee
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
| | - Hee Jae Jun
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine
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Ramanan RV, Ramalingam A. Coronary artery bypass graft failure and its relationship to target artery percentage stenosis and competitive flow. A CT angiographic analysis. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Soylu E, Harling L, Ashrafian H, Athanasiou T. Does coronary endarterectomy technique affect surgical outcome when combined with coronary artery bypass grafting?: Table 1:. Interact Cardiovasc Thorac Surg 2014; 19:848-55. [DOI: 10.1093/icvts/ivu261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] 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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Binsalamah ZM, Al-Sarraf N, Chaturvedi RK, Alam A, Thalib L, Belley G, Shum-Tim D. Mid-term outcome and angiographic follow-up of endarterectomy of the left anterior descending artery in patients undergoing coronary artery bypass surgery. J Card Surg 2013; 29:1-7. [PMID: 24131089 DOI: 10.1111/jocs.12230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM With the advancement of percutaneous coronary interventions (PCIs), more patients with diffuse coronary artery disease are referred for coronary artery bypass graft (CABG) surgery. The use of coronary endarterectomy may be useful in such cases. We reviewed our experience with left anterior descending artery endarterectomy as an adjunct to conventional CABG. METHODS Between June 2005 and 2011, 58 consecutive patients underwent left anterior descending artery endarterectomy as an adjunct to CABG. These were matched to 58 cases based on age, gender, and Parsonnet score. All data were collected prospectively in a departmental database. Postoperative complications and in-hospital mortality were analyzed. Survival curves were produced. RESULTS There was one death in the endarterectomy group (1.7%) from liver failure. There was no significant difference in postoperative complications (especially perioperative myocardial infarction) between the two groups with similar hospital mortality. Computed tomography (CT) angiography was performed in 24 patients with endarterectomy (41%), which showed 100% patency of the left internal mammary artery graft to the left anterior descending artery. Survival and freedom from intervention at a mean follow-up of 4.2 years were similar. CONCLUSIONS In patients with diffuse disease, the use of endarterectomy is a safe technique with no increase in short-term morbidity or mortality. Mid-term results are similar to nonendarterectomized patients. This technique is useful in patients with diffuse coronary artery disease.
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Affiliation(s)
- Ziyad M Binsalamah
- Department of Surgery, Division of Cardiac Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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Kato Y, Takanashi S. Is reconstruction of the left anterior descending artery with saphenous vein patching equal to onlay patch reconstruction using the left internal thoracic artery? J Thorac Cardiovasc Surg 2013; 145:616-7. [PMID: 23321144 DOI: 10.1016/j.jtcvs.2012.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/13/2012] [Indexed: 11/30/2022]
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Reply to the editor. J Thorac Cardiovasc Surg 2012; 145:314-5. [PMID: 23244270 DOI: 10.1016/j.jtcvs.2012.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/02/2012] [Indexed: 11/24/2022]
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Extensive left anterior descending artery endarterectomy and reconstruction. J Thorac Cardiovasc Surg 2012; 145:314. [PMID: 23244269 DOI: 10.1016/j.jtcvs.2012.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 09/13/2012] [Indexed: 11/23/2022]
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